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Preoperative radiotherapy for appendicular bone metastases: outcomes
Jane B Pearce1, Prasamsa Pandey1, Comron Hassanzadeh1
1Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
BMJ Supportive & Palliative Care
|March 2, 2026
Summary
Preoperative radiotherapy (RT) for bone metastases requiring surgery showed promising results. Patients experienced minimal complications and improved pain, suggesting RT may be beneficial before orthopedic intervention.
Area of Science:
- Oncology
- Orthopedic Surgery
- Radiation Oncology
Background:
- Bone metastases are a frequent complication of advanced cancers, often leading to pathologic fractures.
- Prophylactic fixation and radiotherapy (RT) are crucial for managing bone metastases and improving patient quality of life.
- While postoperative RT is standard, the role of preoperative RT for bone metastases is less defined.
Purpose of the Study:
- To evaluate the outcomes of patients with bone metastases who underwent preoperative RT before orthopedic intervention.
- To assess the safety and efficacy of preoperative RT in this patient population.
Main Methods:
- A retrospective review of 10 patients with bone metastases treated with preoperative RT was conducted.
- Descriptive statistics characterized the patient cohort.
- Kaplan-Meier analysis estimated time to subsequent palliative RT and overall survival.
Main Results:
- Ten patients were analyzed, with preoperative RT utilized for various reasons including systemic therapy continuation, RT field reduction, and surgical delays due to comorbidities.
- The median time from RT completion to surgery was 13 days.
- The majority of patients (90%) experienced no postoperative complications, and no local disease recurrence was observed at a median follow-up of 13 months.
Conclusions:
- Preoperative RT for bone metastases requiring orthopedic intervention appears safe and effective, associated with minimal operative complications and pain improvement.
- Further investigation via a randomized clinical trial is warranted to compare preoperative versus postoperative RT for palliation of bone metastases.
