Role of radiation therapy and radiopharmaceuticals in bone metastases

Bone metastases remain the most common cause of cancer-related pain. Palliative radiotherapy and radiopharmaceuticals are effective for symptom control, but continue to be underutilized. We review recent literature for the treatment of bone metastases and spinal cord compression, and address new developments in the prevention of adverse effects secondary to radiotherapy.

Evidence continues to mount in support of the efficacy of short-course radiation schedules. Emerging data support the use of single fractions. While radiotherapy is relatively nontoxic, pain flare can be a distressing side effect. Recent reports suggest that traditional and more innovative radiopharmaceuticals are well tolerated, with effects comparable with external beam radiation and the added advantage of addressing multiple, widespread painful sites simultaneously.

There is an urgent need for more randomized controlled trials in the radiotherapy of complicated bone metastases, such as the settings of spinal cord compression and neuropathic pain. Additional study of radiopharmaceuticals as adjuvants to external beam radiotherapy would also serve to further elucidate the optimal treatment for these patients.