Radiotherapy for bone metastases: indications, methods, and possibilities

Abstract

Introduction. Bone metastases (BM) are a significant challenge in the advanced stages of various cancers, leading to debilitating symptoms and decreased quality of life for patients. Radiotherapy (RT ) plays a crucial role in managing BM by alleviating symptoms and improving local tumour control. RT for bone metastases has undergone substantial scientific and technological advancements, with external beam RT (EBRT ) being the primary approach. Advanced modalities such as intensity modulated RT (IMRT ) and stereotactic body RT (SBRT ) have revolutionised treatment precision, resulting in improved outcomes and reduced toxicities. This narrative review aims to present the current state-of-the-art role of RT in the multidisciplinary management of patients with BM. Spinal metastases are often associated with neurological disorders, pain, and fractures. Palliative EBRT provides pain relief but – lacks sufficient local efficacy. SBRT , with its high local efficacy and tolerability, is recommended for selected cases, including previous radiation or adjuvant treatment after surgical treatment. Qualification for SBRT involves multidisciplinary collaboration and considerations of performance status, cancer progression, and available treatment options. Pathological fractures significantly impact patient performance and quality of life. Early identification of high-risk lesions using tools like the SINS scale for spinal stability and the Mirels scoring system for fracture risk assessment in long bones is crucial. Preventive surgical treatment, including prophylactic stabilisation, is recommended for impending fractures. A comprehensive multidisciplinary approach involving radiation oncologists, medical oncologists, and surgeons is crucial for developing optimal treatment plans for patients with BM. With the advancements in oncology, effective local therapy can improve patients’ chances of continuing systemic treatment and enhance their quality of life.