Radiotherapy in the management of bone pain

Radiotherapy may be indicated for the management of bone metastases because of associated pain, fracture, or neurologic complications. For metastatic bone pain, simple low-dose radiation treatment is usually effective for local problems. When there are multiple sites of bone pain, external beam irradiation using wide-field hemibody techniques is highly effective. An alternative to this approach is the administration of radioisotopes that may localize to the sites of bone metastases, either because they are tumor specific (radioiodine for thyroid cancer) or bone seeking (radioactive phosphorus [32P] and strontium [89Sr]). The primary treatment of pathologic fracture is surgery where possible, but radiotherapy has a major role in postoperative treatment and in treatment of fractures that are inoperable either because of their site, such as a rib or pelvis, or because of the general poor condition of the patient. For neurologic complications such as spinal cord compression or nerve root compression, radiotherapy appears to be as beneficial as decompressive surgery in most situations, except where there is bony instability. The role of radiotherapy in the prophylactic setting is discussed. Prevention of pathologic fracture and spinal cord compression may be possible in high-risk patients.