Palliative treatment of bone metastases

Bone metastases are frequently one of the first signs of disseminated disease in cancer patients and are especially seen in patients with breast, prostate and lung cancer. The prognosis of these patients is generally poor and the treatment is primarily palliative: the intention is to relieve pain, prevent fractures, maintain activity and, if possible, to prolong survival. Besides analgesics the therapeutic options include local treatment with radiotherapy and/or surgery, and systemic treatment using chemotherapy, endocrine therapy, radioisotopes as well as bisphosphonates. Social and psychological supportive care is also very important. Radiotherapy plays an important role, but the other modalities such as bisphosphonates may also offer the same level of palliation, but their definite role has not been as clearly defined. There have been few randomized trials comparing the therapeutic options, and the criteria for assessing response to therapy have, in general, been poorly defined. There is a need for rigorous clinical investigations which assess the efficacy of the various therapeutic possibilities by using well-defined and validated response criteria such as pain and quality of life.