Abstract
Radiotherapy is an extremely effective analgesic treatment of bone metastases the value of which is entirely underestimated. An analgesic effect is achieved in about 80% patients.
In local involvement, external beam radiotherapy is used as a single treatment (one large dose of 8-12 Gy) or a fractionated regimen (2 x 6.5 Gy, 3 x 5 Gy, 5 x 4 Gy or 10 x 3 Gy). In the case of multiple involvement, half-body irradiation (HBI) using external beam is indicated (6 Gy with the upper half, and 8 Gy with the lower half of the body in one fraction with a two weeks' gap).
When using combinations of setrons with corticosteroids, the treatment is well tolerated. Another treatment modality with multiple bone involvement is the administration of radioisotopes with high affinity to bone tissue, usually 89Sr or 186Rh.
This treatment also provides an excellent palliative effect with minimal toxicity. In the case of metastatic bone involvement, a combination of radiotherapy, opioids and bisphosphonates can substantially improve the quality of life of the patient, in some cases complete pain control is obtained.
With hormonally dependent tumors, hormonal manipulation has a role to play in combination therapy. With chemo-sensitive tumors (germinal tumors, myeloma, malignant lymphomas), cytotoxic chemotherapy could be helpful.