Bone Metastases: When Initial Radiotherapy Fails to Relieve Bone Pain

Bone pain in skeletal metastases may persist despite a completed course of radiotherapy, or may return after an initial response. When the first-line radiation approach does not achieve adequate pain relief, escalation to a further treatment strategy is indicated.

Prior treatment — goal not reached

External beam radiotherapy for localised bone pain (using single or multi-fraction regimens), combined with dexamethasone to reduce pain flare, was the first-line approach. The intended goal of bone pain relief was either not achieved or pain subsequently relapsed, making escalation to this protocol appropriate.

Next-step approach & goal

The next treatment step involves a reirradiation or stereotactic body radiotherapy strategy, with the goal of achieving bone pain relief. Specific modality selection, eligibility criteria, and the complete treatment regimen are in the full structured protocol…

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References

DOI: 10.1007/s12094-016-1590-1

Reirradiation may be necessary for patients if the initial treatment fails or there is a subsequent relapse after an initial response.
In selected cases with small-volume skeletal metastasis, limited metastatic tumour burden, and good performance status, SBRT provides a way to deliver a radical treatment.
Current published results suggest that a single-fraction stereotactic radiosurgery at up to 20 Gy can be used for relief of acute bone pain, even for radio-resistant tumour types, such as melanoma and renal cell carcinoma.

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