Bone Metastase Essay

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Metastasis to the bone occurs in 30-70% of cancer patients with metastatic cancer; depending on the primary site of disease.1 Bone metastases can cause severe pain, spinal cord compression, hypercalcemia and pathologic fracture.2 In the subset of cancer patients the goal of treatment is to relieve symptoms caused by the metastasis and/or to control the growth. The primary goal of palliative treatment is to improve patient’s quality of life (QoL) and prevent or treat the symptoms of their disease.
Median survival time of patients with bone metastases is poor and is typically less than one year, depending on the primary site of disease.3 Treatment options for bone metastases include pharmacological interventions, cytotoxic therapy, surgical management, vertebroplasty, kyphoplasty, chemotherapy, external beam radiation
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8 Gy in 1 fraction) and a treatment that is fractionated into more than one fraction is called a multi-fraction treatment (i.e. 30 Gy in 10 factions, and 20 Gy in 5 fractions). In 2011 the American Society for Radiation Oncology (ASTRO) released guidelines for the use of radiation therapy in the treatment of palliative bone metastases based upon current published evidence.2 They concluded that the 8 Gy in 1 fraction is a safe and effective treatment with shorter acute radiation side effects than multi-fraction treatment, and resolution of these side effects begins upon the resolution of treatment making the duration shorter.2 The single-fraction also optimizes patient and caregiver convenience.2 There some situations in which patients would benefit from the multi-fraction treatment: compression (cord or cauda equina) (although this is debated), radicular nerve pain, previous treatment to the spine, those with femoral axial cortical involvement greater than 3 cm in length and those who have had a surgical stabilization procedure.
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