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Radiation Treatment for Metastastic Bone Carcinoma

- Discussion:
    - useful for reducing bone pain and progression of tumor growth;
    - adjuvant radiation may be indicated for all patients with surgically treated metastatic bone disease;
    - external beam radiation is used perioperatively to assist in the local control of the disease in the majority of patients; 

    - outcomes:
           - 90% will receive some relief, and 50% will receive near complete relief with between 20 to 40.5 gray of radiation;
           - patients with mixed or blastic type lesions (often breast and prostate) are more likely reconstitute than lytic lesions;
           - hence radiation treatment of blastic lesions is more likely to be successfully treated without need for IM fixation;
           - in contrast, patients with purely lytic bone lesions of metastatic lung cancer, myeloma, and renal cell cancer rarely reconstitute when treated with radiation;

    - technique:
           - postoperative radiation should ideally start ten to fourteen days after surgery to allow wound-healing;
           - standard dose of 3000 cGy given in 10 fractions generally gives about 80% lasting pain relief from metastatic disease;
                 - relatively low-dose irradiation has not been shown to inhibit healing of pathologic fractures;
           - if IM nail is used then the entire bone should be irradiated;
           - flexible reamers can push tumor cells distal to the implant intraoperatively which can cause hardware failure or new pathologic fractures;

    - complications:
           - radiation induced osteonecrosis:
           - theoretically may increase rate of stress frx or nonunion but this complication developed in only 13/136 patients in the series by Wedin R, et al (1999) 
            - Failures after operation for skeletal metastatic lesions of long bones.

Compressive mechanical properties of human cancellous bone after gamma irradiation.

Effects of irradiation on cortical bone and their time-related changes. A biomechanical and histomorphological study.

Skeletal sequelae of radiation therapy for malignant childhood tumors.

Radiotherapy in the management of bone pain.

General principles of external beam radiation therapy for skeletal metastases.

Fracture healing in metastatic bone disease.

The final report of the expert panel for the radiation oncology bone metastasis work group of the American College of Radiology.

Skeletal sequelae of radiation therapy for malignant childhood tumors.

The management of primary lymphoma of bone.

Chronic radiation myelitis.

Sequential Histomorphometric Analysis of the Growth Plate Following Irradiation with and without Radioprotection.