[Topical radiotherapy in the management of skeletal metastases]

Local radiotherapy plays an important role in the palliative management of bone metastases. Different concepts of dose fractionation are in use. A judgement of the efficacy of these concepts should be based on their different palliative treatment endopoints. The efficacy of radiotherapy using published data can be analysed with respect to pain relief and re-establishment of bone integrity as treatment endopoints. Trials stratifying radiooncological techniques according to an optimization of quality of life are missing. Nevertheless, the rationale for individual treatment in daily work is based on systemic tumor extent, life expectancy, the kind of symptoms and the location of the metastasis in question. In patients with reduced live expectancy a remarkably high chance of pain relief (70%) could be achieved with single doses of 8 Gy. The latency period until pain relief is shorter with higher single doses. In case of recurrence of pain reirradiation with a single dose results in an equally high response rate. Patients with a solitary metastasis, patients with longer live expectancy and patients with pathological fractures should be treated with 'curative' doses, aimed to cause maximum tumor cell killing. Impaired bone stability in patients who are not suitable for surgical intervention requires orthetic supply. Apart from the effect of pain relief, remineralization is the important treatment goal for these patients. Conventional radiotherapy with doses of 40-50 Gy resulted in remineralization in 60-80% of the patients 4-8 weeks after irradiation. Remineralization could not be acceierated by short course fractionation courses.