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Radiotherapy for the Treatment of Bone Metastases

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Interventional Neuroradiology of the Spine

Abstract

Bone metastases are a frequent and severe complication of advanced neoplastic disease. After the lungs and liver, bone is the most frequent site of metastasis. Many advanced cancers, such as lung cancer and prostate cancer in men as well as breast cancer in women, have a strong tropism for the bone. The pain related associated with bone metastases is a major cause of morbidity in cancer patients. Events related to bone metastasis include impaired quality of life (QoL), bone fractures, hypercalcemia, neurological deficits, and movement limitation.

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References

  1. Mundy GR (1987) Bone resorption and turnover in health and disease. Bone 8 (Suppl.1):S9–S16

    Google Scholar 

  2. Mercadante S (1997) Malignant bone pain: pathophysiology and treatment. Pain, 69:1–18

    Article  PubMed  CAS  Google Scholar 

  3. Hsu H, Lacey DL, Dunstan CR et al (1999) Tumour necrosis factor receptor family member RANK mediates osteoclast differentiation and activation induced by osteoprotegerin ligand. Proc Natl Acad Sci U.S.A. 96:3540–3545

    Article  PubMed  CAS  Google Scholar 

  4. Simonet WS, Lacey DL, Dunstan CR et al (1997) Osteoprotegerin: a novel secreted protein involved in the regulation of bone density. Cell 89:309–319

    Article  PubMed  CAS  Google Scholar 

  5. Guise TA, Yin JJ, Thomas RJ, Dallas M, Cui Y, Gillespie MT (2002) Parathyroid hormone-related protein (PTHrP)(1-139) isoform is efficiently secreted in vitro and enhances breast cancer metastasis to bone in vivo. Bone 30(5):670–676

    Article  Google Scholar 

  6. Perrin R G, Laxton AW (2004) Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients. Neurosurg Clin N Am 15:365–373

    Article  PubMed  Google Scholar 

  7. Coleman RE (2006) Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res 12:6243s–6249s

    Article  PubMed  Google Scholar 

  8. Coleman RE (1997) Skeletal complications of malig nancy. Cancer 80 (Suppl.8):1588–1594

    Article  Google Scholar 

  9. Goblirsch MJ, Zwolak PP, Clohisy DR (2006) Biology of bone cancer pain. Clin Cancer Res 12:6231–6235s

    Article  Google Scholar 

  10. Hoskin PJ, Stratford MRL, Folkes LK, Regan J, Yarnold JR (2000) Effect of local radiotherapy for bone pain on urinary markers of osteoclast activity Lancet 355:1428–1429

    Article  PubMed  CAS  Google Scholar 

  11. Roodman GD (2004) Mechanisms of bone metastases. N Engl J Med 350:1655–1664

    Article  PubMed  CAS  Google Scholar 

  12. Smoker WRK, Godersky JC, Knutzon RK et al (1987) The role of MR imaging in evaluating metastatic spinal disease. AJR Am J Roentgenol 149:1241–8

    Article  PubMed  CAS  Google Scholar 

  13. Flickinger FW, Sanal SM (1994) Bone marrow MRI: techniques and accuracy for detecting breast cancer metastases. Magn Reson Imaging 12:829–835

    Article  PubMed  CAS  Google Scholar 

  14. Hamaoka T, Madewell JE, Podoloff DA et al (2204) Bone imaging in metastatic breast cancer. J ClinOncol 22:2942–2953

    Article  Google Scholar 

  15. Evan-Sapr E, Mester U, Mishani E et al (2006) The detection of bone metastases in patients with highrisk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single-and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med 47:287–297

    Google Scholar 

  16. Fujimoto R, Higashi T, Nakamoto Y et al (2006) Diagnostic accuracy of bone metastases detection in cancer patients: comparison between bone scintigraphy and whole-body FDG-PET. Ann Nucl Med 20:399–408

    Article  PubMed  Google Scholar 

  17. Daldrup-Link HE, Franzius C, Link TM (2001) Whole-body MR imaging for detection of bone metastases in children and young adults: comparison with skeletal scintigraphy and FDG PET. Am J Roentgenol 177:229–236

    Article  CAS  Google Scholar 

  18. Ohta M, Tokuda Y, Suzuki Y et al (2001) Whole body PET for the evaluation of bony metastases in patients with breast cancer: comparison with 99Tcm-MDP bone scintigraphy. Nucl Med Commun 22:875–879

    Article  PubMed  CAS  Google Scholar 

  19. Asdourian PL, Weidenbaum M, DeWald RL, Hammerberg KW, Ramsey RG (1990) The pattern of vertebral involvement in metastatic vertebral breast cancer. Clin Orthop Relat Res 250:164–170

    PubMed  Google Scholar 

  20. Steinmetz MP, Mekhail A, Benzel EC (2001) Management of metastatic tumors of the spine: strategies and operative indications. Neurosurg Focus 11:e2

    Article  PubMed  CAS  Google Scholar 

  21. Gurney H, Larcos G, McKay M, Kefford R, Langlands A (1989) Bone metastases in hypernephroma. Frequency of scapular involvement. Cancer 64:1429–1431

    CAS  Google Scholar 

  22. Harrington KD (1986) Metastatic disease of the spine. J Bone Joint Surg Am 68:1110–1115

    PubMed  CAS  Google Scholar 

  23. Harrington KD (1997) Orthopedic surgical management of skeletal complications of malignancy. Cancer 80 (8 Suppl.):1614–1627

    Article  Google Scholar 

  24. Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine 26:298–306

    Article  PubMed  CAS  Google Scholar 

  25. Bartles RH, Feuth T, van der Maazen R (2007) Development of a model with which to predict the life expectancy of patients with spinal epidural metastasis. Cancer 110:2042–2049

    Article  Google Scholar 

  26. Chow E, Harris K, Fung K (2006) Successful validation of a survival prediction model in patients with metastases in the spinal column. Int J Radiat Oncol Biol Phys 65}:1522–1527

    Article  PubMed  Google Scholar 

  27. Aglietta M, Mandoliti G, Marangolo M, Maranzano E (2007) La palliazione in radioterapia oncologica. Argomenti Oncologici Quaderni di Oncologia. Medical Communication, Torino, pp 41–47

    Google Scholar 

  28. van der Linden YM, Dijkstra SPDS, Vonk EJA, Marijnen CAM, Leer JWH (2005) Prediction of survival in patients with metastases in the spinal column. Cancer 103:320–328

    Article  PubMed  Google Scholar 

  29. Poulson HS, Nielsen OS, Klee M, Rorth M (1989) Palliative irradiation of bone metastases. Cancer Treat Rev 16:41–48

    Article  Google Scholar 

  30. Hoskin PJ (1995b) Radiotherapy in the management of bone pain. Clin Orthopaed Res 312:105–119

    Google Scholar 

  31. Peters LJ (1990) The EstroRegaud Lecture. Inherent radiosensitivity of tumor and normal tissue cells as a predictor of human tumor response. Radiother Oncol 17:177–190

    Article  PubMed  CAS  Google Scholar 

  32. Hoskin PJ, Stratford MR, Folkes LK, Regan J, Yarnold JR (2000) Effect of local radiotherapy for bone pain on urinary markers of osteoclast activity. Lancet 355:1428–1429

    Article  PubMed  CAS  Google Scholar 

  33. Hoskin PJ, Yarnold JR, Roos DR, Bentzen S (2001) Radiotherapy for bone metastases. Clin Oncol (R Coll Radiol) 13:88–90

    CAS  Google Scholar 

  34. Wu JS, Wong RK, Lloyd NS, Johnoston M, Bezjak A, Whelan T (2004) Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases — an evidence-based practice guideline. BMC Cancer 4:71

    Article  PubMed  CAS  Google Scholar 

  35. Tong D, Gillik L, Hendrickson FR (1982) The palliation of symptomatic osseous metastases. Final results of the study by the Radiation Therapy Oncology Group. Cancer 50:893–899

    CAS  Google Scholar 

  36. Lutz S, Berk L, Chang E et al (2011) Palliative radiotherapy for bone metastases. An ASTRO evidencebased guideline. Int J Radiat Oncol 4: 965–976

    Article  Google Scholar 

  37. Gibbs IC, Kamnerdsupaphon P, Ryu MR et al (2007) Image-guided robotic radiosurgery for spinal matastases. Radiother Oncol 82:185–190

    Article  PubMed  Google Scholar 

  38. Gerszten PC, Burton SA, Ozhasoglu C, Welch WC (2007) Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine 32:193–199

    Article  PubMed  Google Scholar 

  39. Jin JY, Chen Q, Jin R et al (2007) Technical and clinical experience with spine radiosurgery: a new technology for management of localized spine metastases. Technol Cancer Res Treat 6:127–133

    PubMed  Google Scholar 

  40. Ryu S, Fang Y, Rock J et al (2003) Image-guided and intensity-modulated radiosurgery for patients with spinal metastasis. Cancer 97:2013–2018

    Article  PubMed  Google Scholar 

  41. Nieder C, Grosu AL, Andratschke NH, Molls M (2006) Update of human spinal cord reirradiation tolerance based on additional data from 38 patients. Int J Radiat Oncol Biol Phys 66:1446–1449

    Article  PubMed  Google Scholar 

  42. Trodella L, Ramella S, D’Angelilla RM, Orecchia R, Muto P (2011) Radiation therapy for bone metastases. Tumori 12 (suppl. 1):S12–S17

    Google Scholar 

  43. Janian N (2001) Bone metastases: approaches to management. Semin Oncol 28:28–34

    Google Scholar 

  44. Roos D, Turner S, O’Brien P et al; TROG 96.05 (2005) Randomized trial of 8 Gy in 1 versus 20 Gy in 5 fractions of radiotherapy for neuropathic pain due to bone matastases. Radiother Oncol 75:54–63

    Article  PubMed  Google Scholar 

  45. Maranzano E, Latini P, Checcaglini F et al (1992) Radiation therapy of spinal cord compression caused by breast cancer: report of a prospective trial. Int J Radiat Oncol Biol Phys 24:301–306

    Article  PubMed  CAS  Google Scholar 

  46. Steenland E, Leer J, van Houwelingen et al (1999) The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study. Radiother Oncol 52:101–109

    Article  PubMed  CAS  Google Scholar 

  47. Rades D, Fehlauer F, Schulte R et al (2006) Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression. J Clin Oncol 24:3388–3393

    Article  PubMed  Google Scholar 

  48. Maranzano E, Trippa F, Casale M, Anselmo P, Rossi R (2011) Reirradiation of metastatic spinal cord compression: definitive results of two randomized trials. Radiother Oncol 98:234–237

    Article  PubMed  Google Scholar 

  49. Patchell RA, Tibbs PA, Regine WF et al (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366:643–648

    Article  PubMed  Google Scholar 

  50. Hirabayashi H, Ebara S, Kinoshita T (2003) Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases. Cancer 97:476–484

    Article  PubMed  Google Scholar 

  51. Pilitsis JG, Rengachary SS (2001) The role of vertebroplasty in metastatic spinal disease. Neurosurg Focus11:e1

    Google Scholar 

  52. De Negri P, Tirri T, Paternoster G, Modano P (2007) Treatment of painful osteoporotic or traumatic vertebral compression fractures by percutaneous vertebral augmentation procedures: a nonrandomized comparison between vertebroplasty and kyphoplasty. Clin J Pain 23:425–430

    Article  PubMed  Google Scholar 

  53. Wenger M (2003) Vertebroplasty for metastasis. Med Oncol 20:203–209

    Article  PubMed  Google Scholar 

  54. Fuentes S, Metellus P, Pech-Gourg G (2007) Traitement par Kyphoplastieafoyer ouvert des metastases rachidiennes. Neurochirurgie 53:49–53

    Article  PubMed  CAS  Google Scholar 

  55. Poulson HS, Nielsen OS, Klee M, Rorth M (1989) Palliative irradiation of bone metastases. Cancer Treat Rev 16: 41–48

    Article  Google Scholar 

  56. Hoskin PJ (1995) Radiotherapy in the management of bone pain. Clin Orthop Rel Res 312:105–119

    Google Scholar 

  57. Coleman-Robert E (2000) Management of bone metastases. Oncologist 5:465–466

    Google Scholar 

  58. Colston KW (2000) Bisphosphonates induce apoptosis in human breast cancer cell lines. Brit J Cancer 82:366–371

    Google Scholar 

  59. Jagdev SP, Coleman RE, Shipman CM, Ro-stami HA, Croucher PI (2001) The bisphosphonates zole dronic acid induces apoptosis of breast cancer cells: evidence for synergy with paclitaxel. Brit J Cancer 84:1126–1134

    Article  PubMed  CAS  Google Scholar 

  60. Lee MV, Fong EM, Singer FR, Guenette RS (2001) Bisphosphonate treatment inhibits the growth of prostate cancer cells. Cancer Res 61:2602–2608

    PubMed  CAS  Google Scholar 

  61. Riebeling C, Forsea AM, Raisova M, Orfanos CE, Geilen CC (2002) The bisphosphonate pamidronate induces apoptosis in human melanoma cells in vitro. Brit J Cancer 87:366–371

    Article  PubMed  CAS  Google Scholar 

  62. Mackie PS, Fisher JL, Zhou H, Choong PF (2001) Bisphosphonates regulate cell growth and gene expression in the UMR 106-101 clonal rat osteosarcoma cell line. Brit J Cancer 84:951–958

    Article  PubMed  CAS  Google Scholar 

  63. Shipman CM, Croucher PI, Russell RG, Hel-frich MH, Rogers MJ (1998) The bisphosphonate incadronate (YM175) causes apoptosis of human myeloma cells in vitro by inhibiting the mevalonate pathway. Cancer Res 58:5294–5297

    PubMed  CAS  Google Scholar 

  64. Ugur-Ural A, Avcuand F, Baran Y (2008) bisphosphonate treatment and radiotherapy in metastatic breast cancer. Med Oncol 25:350–355

    Article  Google Scholar 

  65. Mandoliti G, Ramella S, Muto P et al (2011) Integrating radiation therapy and bisphosphonates. I supplementi di Tumori 12:S7–S11

    Google Scholar 

  66. Krempiem R, Huber PE, Harms W, Treiber M, Wannenmacher M, Krempiem B (2003) Combination of early bisphosphonates administration and irradiation leads to improved remineralization and restabilization of oste-olytic bone metastases in an animal tumor model. Cancer 98:1318–1324

    Article  Google Scholar 

  67. Kouloulias V, Matsopoulos G, Kouvaris J et al (2003) Radiotherapy in conjunction with intravenous infusion of 180 mg sodium pamidronate in the management of oste-olytic metastases from breast cancer: clinical evaluation, biochemical markers, quality of life, and monitoring of recalcification using assessments of gray level histogram in plain radiographs. Int J Radiat Oncol Biol Phys 57:143–157

    Article  PubMed  CAS  Google Scholar 

  68. Rosen LS, Gordon D, Tchekmedyian S et al; Zoledronic Acid Lung Cancer and other Solid Tumors Study Group (2003) Zoledronic acid versus placebo in the treatment of skeletal metastases in patients with lung cancer and other solid tumors: a phase III, doubleblind, randomized trial. J Clin Oncol 21:3150–3157

    Article  PubMed  CAS  Google Scholar 

  69. Hoskin PJ (2003) Bisphosphonates and radiation therapy for palliation of metastatic bone disease. Cancer Treat Rev 29:321–327

    Article  PubMed  CAS  Google Scholar 

  70. Hemming L, Maher D (2005) Cancer pain in palliative care: why is management so difficult? Br J Community Nurs 10:362–367

    PubMed  Google Scholar 

  71. World Health Organization (1986) Cancer pain relief. World Health Organization, Geneva

    Google Scholar 

  72. Takeda F (1985) Japanese field-testing of WHO guidelines. PRN Forum 4:4–5

    PubMed  CAS  Google Scholar 

  73. Walker VA, Hoskin PJ, Hanks GW, White ID (1988) Evaluation of WHO analgesic guidelines for cancer pain in a hospital based palliative care unit. J Pain Symptom Manage 3:145–149

    Article  PubMed  CAS  Google Scholar 

  74. Hanks GW, Conno F, Cherny N et al; Expert Working Group of the Research Network of the European Association for Palliative Care (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Brit J Cancer 2001 84:587–593

    Article  CAS  Google Scholar 

  75. Ripamonti C, Dickerson ED (2001) Strategies for the treatment of cancer pain in the new millennium. Drugs 61:955–977

    Article  PubMed  CAS  Google Scholar 

  76. Lo Presti C, Roscetti A, Muriess D, Mammucari M (2010) Time to pain relief after immediate-release morphine in episodic pain. The TIME Study. Clin Drug Invest 30(Suppl.2)}:49–55

    Google Scholar 

  77. Mammucari M, Mediati RD, Vellucci R. (2010) L’uso degli oppiacei nella pratica clinica 2010. Wolters Kluwer Health Italy Ltd, Milan

    Google Scholar 

  78. Murino P, Mammucari M, Borrelli D et al (2011) Role of immediate-release morphine (MIR) in the treatment of predictable pain in radiotherapy. J Pain Palliat Care Pharmacother 25:121–124

    Article  PubMed  CAS  Google Scholar 

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  1. Radiotherapy Unit, INT IRCCS Fondazione G. Pascale, Naples, Italy

    Paolo Muto

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  1. Rossella Di Franco
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  2. Sara Falivene
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  3. Vincenzo Ravo
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  4. Paolo Muto
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Correspondence to Paolo Muto .

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  1. Neuroradiology Department, A. Cardarelli Hospital, Naples, Italy

    Mario Muto

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Di Franco, R., Falivene, S., Ravo, V., Muto, P. (2013). Radiotherapy for the Treatment of Bone Metastases. In: Muto, M. (eds) Interventional Neuroradiology of the Spine. Springer, Milano. https://doi.org/10.1007/978-88-470-2790-9_17

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  • DOI: https://doi.org/10.1007/978-88-470-2790-9_17

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