Bone metastases is a common cause of severe cancer pain in malignancy. Most common cancers which are likely to spread to bones are breast, lung, prostate, thyroid and kidney. Most common sites of bone metastases are spine, pelvis,ribs,femur and skull. In the spine, lumbar vertebra is more commonly affected than dorsal followed by cervical vertebra. One percent of bone metastases lead to fracture, out of these femur is the most common site for pathological fracture.
Workup includes bone scan, PET scan, plain Xray, MRI and work up for primary tumor.
Treatment depends on many factors like number of bone metastases, site of metastases, extent of cortical bone involvement, status of primary tumor, pain score , life expectancy and previous treatment given.
Treatment includes surgery, radiation, chemotherapy and radionuclide therapy. Surgery is usually done for pathological fracture or impending fracture that would cause instability and loss of function. For spine lesions, vertebroplasty and kyphoplasty can also be done . Radiation is the most commonly used modality for relief of pain Palliative doses of radiation give good pain relief in a shorter period of time. These days, spine SBRT is also frequently used as it gives higher biological effective dose (BED) with greater conformality than standard radiation. Ideal patient for spine SBRT are patients with good performance status, disease confined to 1-2 spinal segments and no epidural diease. Excellent pain control and disease response seen in most of the cases.
Radium 223 and strontium 89 are also used for disseminated bone metastases with no fracture or cord compression .
Certain supportive therapy like denosumab and zolendronic acid are given to reduce skeletal related events and bone pains.
Good pain relief in bone metastases can also improve quality of life and life expectancy.
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