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Radiotherapeutic approaches to metastatic disease

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Abstract

Bone metastases in patients with prostate cancer are common. Prostate cancer patients also have a relatively long survival. Palliative radiation can provide effective symptom control in many clinical settings. This article focuses on the management of bone pain and its complications (pathological fractures and spinal cord compression) with radiation treatment.

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References

  1. Whitmore WJ Jr (1984) Natural history and staging of prostate cancer. Urol Clin North Am 11:209–220

    Google Scholar 

  2. Chodak G, Thisted R, Gerber G, et al. (1994) Results of conservative management of clinically localized prostate cancer. N Engl J Med 330:242–248

    CAS  PubMed  Google Scholar 

  3. Batson O (1940) The function of the vertebral veins and their role in the spread of metastases. Ann Surg 112:138–149

    Google Scholar 

  4. Dodds P, Caride V, Lytton B (1981) The role of vertebral veins in the dissemination of prostatic carcinoma. J Urol 126:753–755

    CAS  PubMed  Google Scholar 

  5. Perez C (1997) Prostate. In: Perez C, Brady L (eds) Principles and practice of radiation oncology. Lippincott-Raven, Philadelphia, pp 1583–1694

  6. McCarthy P, Pollack H (1991) Imaging of patients with stage D prostatic carcinoma. Urol Clin North Am 18:35–53

    CAS  PubMed  Google Scholar 

  7. Allen K, Johnson T, Hibbs G (1976) Single-dose irradiation of bone metastases. Acta Radiol Ther Phys Biol 15:337–339

    PubMed  Google Scholar 

  8. Arcangeli G, Micheli A, Arcangeli G, et al. (1989) The responsiveness of bone metastasis to radiotherapy: the effect of site, histology and radiation dose on pain relief. Radiother Oncol 14:95–101

    CAS  PubMed  Google Scholar 

  9. Garmatis C, Chu F (1978) The effectiveness of radiation therapy in the treatment of bone metastases from breast cancer. Radiology 16:235–237

    Google Scholar 

  10. Gilbert R, Kim J, Posner J (1978) Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol 3:40–51

    CAS  PubMed  Google Scholar 

  11. Jensen N, Roesdahl K (1976) Single-dose irradiation of bone metastases. Acta Radiol Ther Phys Biol 15:337–339

    PubMed  Google Scholar 

  12. Kumar P, Bahrassa F, Espinoza M (1978) The role of radiotherapy in management of metastatic bone disease. J Natl Med Assoc 70:909–911

    CAS  PubMed  Google Scholar 

  13. Schocker J, Brady L (1982) Radiation therapy for bone metastases. Clin Orthop 169:38–43

    PubMed  Google Scholar 

  14. Vargha Z, Glicksman A, Beland J (1969) Single-dose radiation therapy in the palliation of metastatic disease. Radiology 93:1181–1184

    CAS  PubMed  Google Scholar 

  15. Qasim M (1977) Single-dose palliative irradiation for bony metastases. Strahlentherapie 153:531–532

    CAS  PubMed  Google Scholar 

  16. Tong D, Gillick L, Hendrickson F (1982) The palliation of symptomatic osseous metastases: final results of the study by the Radiation Therapy Oncology Group. Cancer 50:893–899

    CAS  PubMed  Google Scholar 

  17. Blitzer P (1985) Reanalysis of the RTOG study of the palliation of symptomatic osseous metastases. Cancer 55:1468–1472

    CAS  PubMed  Google Scholar 

  18. Price P, Hoskin P, Easton D, et al. (1986) Prospective randomized trial of single and multi-fraction radiotherapy schedules in the treatment of painful bony metastases. Radiother Oncol 6:247–255

    CAS  PubMed  Google Scholar 

  19. Hoskin PJ, Price P, Easton D, et al. (1992) A prospective randomized trial of 4 Gy or 8 Gy single doses in the treatment of metastatic bone pain. Radiother Oncol 23:74–78

    CAS  PubMed  Google Scholar 

  20. Bone Pain Trial Working Party (1999) 8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomized comparison with multi-fraction schedule over 12 months of patient follow-up. Radiother Oncol 52:111–121

    Article  PubMed  Google Scholar 

  21. Steenland E, Leer J, van Houwelingen H, 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  CAS  PubMed  Google Scholar 

  22. Nielsen O, Bentzen S, Sandberg E, et al. (1998) Randomized trial of single dose versus fractionated palliative radiotherapy of bone metastases. Radiother Oncol 47:233–240

    Article  CAS  PubMed  Google Scholar 

  23. Jeremic B, Shibamoto Y, Acimovic L, et al. (1998) A randomized trial of three single-dose radiation therapy regimens in the treatment of metastatic bone pain. Int J Radiat Oncol Biol Phys 42:161–167

    Article  CAS  PubMed  Google Scholar 

  24. Gaze M, Kelly C, Kerr G, et al. (1997) Pain relief and quality of life following radiotherapy for bone metastases: a randomized trial of two fractionation schedules. Radiother Oncol 45:109–116

    Article  CAS  PubMed  Google Scholar 

  25. Niewald M, Tkocz H, Abel U, et al. (1996) Rapid course radiation therapy vs. more standard treatment: a randomized trial for bone metastases. Int J Radiat Oncol Biol Phys 36:1085–1089

    Article  CAS  PubMed  Google Scholar 

  26. Ratanatharathorn V, Powers W, Moss W, et al. (1999) Bone metastasis: review and critical analysis of random allocation trials of local field treatment. Int J Radiat Oncol Biol Phys 44:1–18

    Article  CAS  PubMed  Google Scholar 

  27. Chow E, Danjoux C, Wong R, et al. (2000) Palliation of bone metastases: a survey of patterns of practice among Canadian radiation oncologists. Radiother Oncol 56:305–314

    Article  CAS  PubMed  Google Scholar 

  28. Duncan G, Duncan W, Maher EJ (1993) Patterns of palliative radiotherapy in Canada. Clin Oncol 5:92–97

    CAS  Google Scholar 

  29. Ben-Josef E, Shamsa F, Williams A, et al. (1998) Radiotherapeutic management of osseous metastases: a survey of current patterns of care. Int J Radiat Oncol Phys 40:915–921

    Article  CAS  Google Scholar 

  30. Hartsell W, Shah A, Graney M, et al. (1998) Palliation of bone metastases in the USA: a survey of patterns of practice (abstract 45). Support Care Cancer 6:175

    Google Scholar 

  31. Bentzen S, Hoskin P, Roos D, et al. (2000) Fractionated radiotherapy for metastatic bone pain: evidence-based medicine or ...? Int J Radiat Oncol Biol Phys 46:681–682

    Article  CAS  PubMed  Google Scholar 

  32. Chow E, Danjoux C, Connolly R, et al. (2000) Bone metastasis: review and critical analysis of random allocation trial of local field treatment: regarding Ratanatharathorn et al. Int J Radiat Oncol Biol Phys 46:517–518

    CAS  PubMed  Google Scholar 

  33. Ratanatharathorn V, Powers W, Moss W, et al. (2000) Response to the letter from Dr. Edward Chow and associates to the editor. Int J Radiat Oncol Bio Phys 46:518

    Article  Google Scholar 

  34. Ratanatharathorn V, Powers W, Moss W, et al. (2000) In response to Dr. Bentzen et al. Int J Radiat Oncol Biol Phys 46:682–683

    Article  Google Scholar 

  35. Needham P, Mithal N, Hoskin P (1994) Radiotherapy for bone pain. J R Soc Med 87:503–505

    CAS  PubMed  Google Scholar 

  36. Wu J, Wong R, Johnston M, et al. on behalf of the Cancer Care Ontario Practice Guidelines Initiative Supportive Care Group (2003) Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases Int J Radiat Oncol Biol Phys 55:594–605

    Google Scholar 

  37. van den Hout W, van der Linden Y, Steenland E, et al. for the Dutch Bone Metastasis Study Group (2003) Single- versus multiple-fraction radiotherapy in patients with painful bone metastases: cost-utility analysis based on a randomized trial. J Natl Cancer Inst 95:222–229

    PubMed  Google Scholar 

  38. Fitzpatrick P, Rider W (1976) Half body irradiation. Int J Radiat Oncol Biol Phys 1:197–207

    CAS  PubMed  Google Scholar 

  39. Hoskin P, Ford H, Harmer C (1989) Hemibody irradiation (HBI) for metastatic bone pain in two histologically distinct groups of patients. Clin Oncol 1:67–69

    CAS  Google Scholar 

  40. Kuban D, Delbridge T, El-Mahdi A, et al. (1989) Half-body irradiation for treatment of widely metastatic adenocarcinoma of the prostate. J Urol 141:572–574

    CAS  PubMed  Google Scholar 

  41. Salazar O, Rubin P, Hendrickson F, et al. (1986) Single-dose half-body irradiation for palliation of multiple bone metastases from solid tumors. final radiation therapy oncology group report. Cancer 58:29–36

    CAS  PubMed  Google Scholar 

  42. Dearnaley D, Bayly R, A'Hern R, et al. (1992) Palliation of bone metastases in prostate cancer. Hemibody irradiation or strontium-89? Clin Oncol 4:101–107

    CAS  Google Scholar 

  43. Priestman T, Roberts J, Lucraft H, et al. (1990) Results of a randomized, double-blind comparative study of ondansetron and metoclopramide in the prevention of nausea and vomiting following high-dose upper abdominal irradiation. Clin Oncol 2:71–75

    CAS  Google Scholar 

  44. Quilty P, Kirk D, Bolger J, et al. (1994) A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer. Radiother Oncol 31:33–40

    CAS  PubMed  Google Scholar 

  45. Van Dyk J, Keane T, Kan S, et al. (1981) Radiation pneumonitis following large single dose irradiation: a re-evaluation based on absolute dose to lung. Int J Radiat Oncol Biol Phys 7:461–467

    PubMed  Google Scholar 

  46. Zelefsky M, Scher H, Forman J, et al. (1989) Palliative hemiskeletal irradiation for widespread metastatic prostate cancer: a comparison of single dose and fractionated regimens. Int J Radiat Oncol Biol Phys 17:1281–1285

    CAS  PubMed  Google Scholar 

  47. Poulter C, Cosmatos D, Rubin P, et al. (1992) A report of RTOG 8206: a phase III study of whether the addition of single dose hemibody irradiation to standard fractionated local field irradiation is more effective than local field irradiation alone in the treatment of symptomatic osseous metastases. Int J Radiat Oncol Biol Phys 23:207–214

    CAS  PubMed  Google Scholar 

  48. Salazar O, Sandhu T, Da Motta N, et al. (2001) Fractionated half-body irradiation (HBI) for the rapid palliation of widespread, symptomatic, metastatic bone disease: a randomized phase III trial of the international atomic energy agency (IAEA). Int J Radat Oncol Biol Phys 50:765–775

    Article  CAS  Google Scholar 

  49. Eary J, Collins C, Stabin M, et al. (1993) Samarium-153-EDTMP biodistribution and dosimetry estimation. J Nucl Med 34:1031–1036

    CAS  PubMed  Google Scholar 

  50. McEwan A (2000) Use of radionuclides for the palliation of bone metastases. Semin Radiat Oncol 10:103–114

    CAS  PubMed  Google Scholar 

  51. Porter A, McEwan A, Powe J (1993) Results of a randomized phase III trial to evaluate the efficacy of strontium-89 adjuvant to local field external beam irradiation in the management of endocrine resistant metastatic prostate cancer. Int J Radiat Oncol Biol Phys 25:805–813

    CAS  PubMed  Google Scholar 

  52. Porter A, McEwan A (1993) Strontium-89 as an adjuvant to external beam radiation improves pain relief and delays disease progression in advanced prostate cancer: results of a randomized controlled trial. Semin Oncol 20:38–43

    CAS  PubMed  Google Scholar 

  53. Blake G, Zivanovic M, Blaquiere R, et al. (1988) Strontium-89 therapy: measurement of absorbed dose to skeletal metastases. J Nucl Med 29:549–557

    CAS  PubMed  Google Scholar 

  54. Breen S, Powe J, Porter A (1992) Dose estimation of strontium-89 radiotherapy of metastatic prostatic carcinoma. J Nucl Med 33:1316–1323

    CAS  PubMed  Google Scholar 

  55. Blake G, Wood J, Wood P, et al. (1989) Sr therapy: strontium plasma clearance in disseminated prostatic carcinoma. Eur J Nucl Med 15:49–54

    CAS  PubMed  Google Scholar 

  56. Lewington V, McEwan A, Ackery D, et al. (1991) A prospective randomized double-blind crossover study to examine the efficacy of strontium-89 pain palliation in patients with advanced prostate cancer metastatic to bone. Eur J Cancer 27:954–958

    CAS  PubMed  Google Scholar 

  57. Buchali K, Correns H, Schuerer M, et al. (1988) Results of a double-blind study of 89-strontium therapy of skeletal metastases of prostatic carcinoma. Eur J Nucl Med 14:349–351

    CAS  PubMed  Google Scholar 

  58. McEwan A, Amyotte G, McGowan D, et al. (1994) A retrospective analysis of the cost effectiveness of treatment with Metastron (89Sr-chloride) in patients with prostate cancer metastatic to bone. Nucl Med Commun 15:499–504

    CAS  PubMed  Google Scholar 

  59. Malmberg I, Persson U, Ask A, et al. (1997) Painful bone metastases in hormone-refractory prostate cancer: economic costs of strontium-89 and/or external radiotherapy. Urology 50:747–753

    Article  CAS  PubMed  Google Scholar 

  60. Finkelstein E, Veldkamp L (2001) Effect of external beam irradiation on the uptake and distribution of samarium-153 EDTMP. Int J Radiat Oncol Biol Phys 51 [Suppl 1]:237–238

    Google Scholar 

  61. Tian J, Zhang J, Hou Q, et al. (1999) Multi-centre trial on the efficacy and toxicity of single-dose samarium-153-ethylene diamine tetramethylene phosphonate as a palliative treatment for painful skeletal metastases in China. Eur J Nucl Med 26:2–7

    Article  CAS  PubMed  Google Scholar 

  62. Dickie GJ, Macfarlane D (1999) Strontium and samarium therapy for bone metastases from prostate carcinoma. Australas Radiol 43:476–479

    Article  CAS  PubMed  Google Scholar 

  63. Sartor O, Bushnell D, Reid R, Quick D (2001) Repeated administration of Sm-153-Lexidronam in the treatment of painful bone metastases (abstract 1036). Proc ASCO 20

  64. Resche I, Chatal J-F, Pecking A, et al. (1997) A dose-controlled study of 153 SM-ethylene diaminectetramethylenephosphonate (EDTMP) in the treatment of patients with painful bone metastases. Eur J Cancer 33:1583–1591

    Article  CAS  PubMed  Google Scholar 

  65. Serafini AN, Houston SJ, Resche I, et al. (1998) Palliation of pain associated with metastatic bone cancer using Samarium-153 Lexidronam: a double-blind placebo-controlled clinical trial. J Clin Oncol 16:1574–1581

    CAS  PubMed  Google Scholar 

  66. Sartor O, Quick D, Reid R, et al. (1997) A double blind placebo-controlled study of 153-samarium-EDTMP for palliation of bone pain in patients with hormone-refractory prostate cancer (abstract 1252). 92nd Annual Meeting of the American Urological Association

  67. Parkes CM (1972) Accuracy of predictions of survival in later stages of cancer. Br Med J 2:29–31

    CAS  PubMed  Google Scholar 

  68. Forster LE, Lynn J (1988) Predicting life span for applicants to in-patient hospice. Arch Intern Med 148:2540–2543

    CAS  PubMed  Google Scholar 

  69. Townsend PW, Rosenthal HG, Smalley SR, et al. (1994) Impact of post-operative radiation therapy and other perioperative factors on outcome after orthopedic stabilization of impending or pathological fractures due to metastatic disease. J Clin Oncol 12:2345–2350

    CAS  PubMed  Google Scholar 

  70. Pouslen HS, Nielson OS, Klee M, Rorth M (1989) Palliative irradiation of bone metastases. Cancer Treat Rev 16:41–48

    PubMed  Google Scholar 

  71. Sylvester JE, Greenberg P, Selch MT, Thomas BJ, Amstutz H (1988) The use of postoperative irradiation for the prevention of heterotopic bone formation after total hip replacement. Int J Radiat Oncol Biol Phys 14:471–476

    CAS  PubMed  Google Scholar 

  72. Blake DD (1970) Radiation treatment of metastatic bone disease. Clin Orthop 73:89–100

    CAS  PubMed  Google Scholar 

  73. Ford HT, Yarnold JR (1983) Radiation therapy—pain relief and recalcification. In: Toll BA, Parbhoo S (eds) Bone metastases: monitoring and treatment. Raven Press, New York, pp 343–354

  74. Schmidt RG (1995) Management of extremity metastatic bone cancer. Curr Probl Cancer 19:166–182

    CAS  PubMed  Google Scholar 

  75. Galasko CS (1988) The role of the orthopaedic surgeon in the treatment of bone pain. Cancer Surv 7:103–125

    CAS  PubMed  Google Scholar 

  76. Habermann ET, Lopez RA (1989) Metastatic disease of bone and treatment of pathological fractures. Orthop Clin North Am 20:469–486

    PubMed  Google Scholar 

  77. Katzner M, Schvingt E (1989) Bone metastases of breast cancer. Surgical treatment of 228 sites in the limbs (in French). Chirurgie 115:741–750

    CAS  PubMed  Google Scholar 

  78. Schurman DJ, Amstutz HC (1973) Orthopedic management of patients with metastatic carcinoma of the breast. Surg Gynecol Obstet 137:831–836

    CAS  PubMed  Google Scholar 

  79. Snell W, Beals RK (1964) Femoral metastases and fractures from breast cancer. Surg Gynecol Obstet 119:22–24

    CAS  Google Scholar 

  80. Beals RK, Lawton GD, Snell WE (1971) Prophylactic internal fixation of the femur in metastatic breast cancer. Cancer 28:1350–1354

    CAS  PubMed  Google Scholar 

  81. Menck H, Schultze S, Larsen E (1988) Metastasis size in pathologic femoral fractures. Acta Orthop Scand 59:151–154

    CAS  PubMed  Google Scholar 

  82. Ryan JR, Rowe DE, Salciccioli GG (1976) Prophylactic internal fixation of the femur for neoplastic lesions. J Bone Joint Surg 58:1071–1074

    CAS  PubMed  Google Scholar 

  83. Fidler M (1973) Prophylactic internal fixation of secondary neoplastic deposits in long bones. Br Med J I:341–343

    Google Scholar 

  84. Fidler M (1981) Incidence of fracture through metastases in long bones. Acta Orthop Scand 52:623–627

    CAS  PubMed  Google Scholar 

  85. Mirels II (1989) Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop 249:256–264

    PubMed  Google Scholar 

  86. Bertin KC, Horstman J, Coleman S (1984) Isolated fracture of the lesser trochanter in adults. An initial manifestation of metastatic malignant disease. J Bone Joint Surg 66:770–773

    CAS  PubMed  Google Scholar 

  87. Phillips CD, Pope TJ Jr, Jones JF (1988) Nontraumatic avulsion of the lesser trochanter: a pathognomonic sign of metastatic disease. Skeletal Radiol 17:106–110

    CAS  PubMed  Google Scholar 

  88. Jardines L, Callans LS, Torosian MH (1993) Recurrent breast cancer: presentation, diagnosis, and treatment. Semin Oncol 20:538–547

    CAS  PubMed  Google Scholar 

  89. Gristina AG, Adair DM, Spurr CL (1983) Intraosseous metastatic breast cancer treatment with internal fixation and study of survival. Ann Surg 197:128–134

    CAS  PubMed  Google Scholar 

  90. Tan JL, Lo NN, Tan SK (1992) Surgical treatment of metastatic long bone disease. Singapore Med J 33:355–358

    CAS  PubMed  Google Scholar 

  91. Yasawa Y, Frassica FJ, Chao EY, et al. (1990) Metastatic bone disease. Clin Orthop 251:213–219

    PubMed  Google Scholar 

  92. Hardman PD, Robb JE, Kerr GR, et al. (1992) The value of internal fixation and radiotherapy in the management of upper and lower limb bone metastases. Clin Oncol 4:244–248

    CAS  Google Scholar 

  93. Cheng DS, Seitz CB, Eyre HJ (1980) Nonoperative management of femoral, humeral, and acetabular metastases in patients with breast carcinoma. Cancer 45:1533–1537

    CAS  PubMed  Google Scholar 

  94. Bessler W, Weber S (1977) Die Strahlenbehandlung von Knochenmetastasen bei Mammacarcinom. Schweiz Rundsch Med Prax 66:140

    CAS  PubMed  Google Scholar 

  95. Garmatis GJ, Chu FCH (1978) The effectiveness of radiation therapy in the treatment of bone metastases from breast cancer. Radiology 126:235

    CAS  PubMed  Google Scholar 

  96. Koswig S, Budach V (1999) Remineralization and pain relief in bone metastases after different radiotherapy fractions (10 times 3 Gy vs. 1 time 8 Gy). A prospective study (in German). Strahlenther Onkol 175:500–508

    Article  CAS  PubMed  Google Scholar 

  97. Loblaw DA, Zhou S, Laperriere NJ, Mackillop WJ (1999) A population-based study of malignant spinal cord compression, presented at 41st Annual Meeting of the American Society of Radiation Oncology Biology and Physics, San Antonio (abstract 2102). Int J Radiat Oncol Biol Phys 45:329

    Google Scholar 

  98. Gilbert RW, Kim J-H, Posner JB (1978) Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol 3:40–51

    CAS  PubMed  Google Scholar 

  99. Helweg-Larsen S (1996) Clinical outcome in metastatic spinal cord compression. A prospective study of 153 patients. Acta Neurol Scand 94:264–275

    PubMed  Google Scholar 

  100. Loblaw DA, To T, Cohen M, Laperriere NJ, Detsky AS (2002) The accuracy of a linked administrative database of malignant spinal cord compression in Ontario cancer patients, presented at Annual Meeting of the Canadian Association of Radiation Oncology, Toronto, 2002 (abstract 144). Radiother Oncol 65 [Supp1]:S34

  101. Loblaw DA, To T, Cohen M, Laperriere NJ, Detsky AS (2002) The accuracy of a linked administrative database of malignant spinal cord compression in Ontario cancer patients. Department of Health Promotion, Management and Evaluation. University of Toronto, Toronto

  102. Talcott JA, Stomper PC, Drislane FW, et al. (1999) Assessing suspected spinal cord compression. A multidisciplinary outcomes analysis of 342 episodes. Support Care Cancer 7:31–38

    Article  CAS  PubMed  Google Scholar 

  103. Loblaw DA, Laperriere NJ, Mackillop WJ (2000) Who should be screened for malignant spinal cord compression? Defining a high-risk population (abstract 142). Clin Invest Med 23:S23

    Google Scholar 

  104. Bayley A, Milosevic M, Gospodarowicz M, Blend R (2001) A prospective study of factors predicting clinically occult spinal cord compression in patients with metastatic prostate cancer. Cancer 92:303–310

    Article  CAS  PubMed  Google Scholar 

  105. Loblaw DA, Laperiere NJ (1998) Emergency treatment of malignant extradural spinal cord compression: an evidence-based guideline. J Clin Oncol 16:1613–1624

    CAS  PubMed  Google Scholar 

  106. Loblaw DA, Laperriere NJ, Chambers A, Perry J, Group at CCOPGIN-ODS (2003) Diagnosis and management of malignant epidural spinal cord compression (Evidence Summary Report No. 9–9). Cancer Care Ontario, 2003. http://www.ccopebc.ca./neucpg.html. Accessed: 4 April 2003

  107. Pigott KH, Baddeley H, Maher EJ (1994) Pattern of disease in spinal cord compression on MRI scan and implications for treatment. Clin Oncol 6:7–10

    CAS  Google Scholar 

  108. Zelefsky MJ, Scher HI, Krol G, Portenoy RK, Leibel SA, Fuks ZY (1992) Spinal epidural tumor in patients with prostate cancer. Clinical and radiographic predictors of response to radiation therapy. Cancer 70:2319–2325

    CAS  PubMed  Google Scholar 

  109. Gonzalez-Barcena D, Vadillo-Buenfil M, Cortez-Morales A, et al. (1995) Luteinizing hormone-releasing hormone antagonist cetrorelix as primary single therapy in patients with advanced prostatic cancer and paraplegia due to metastatic invasion of spinal cord. Urology 45:275–281

    Article  CAS  PubMed  Google Scholar 

  110. Cassileth BR SE, Soloway MS, et al. (1989) Patients' choice of treatment in stage D prostate cancer. Urology 33:57–62

    CAS  Google Scholar 

  111. Bubley GJ (2001) Is the flare phenomenon clinically significant? Urology 58:5–9

    Article  CAS  Google Scholar 

  112. Bok RA, Small EJ (1999) The treatment of advanced prostate cancer with ketoconazole: safety issues. Drug Saf 20:451–458

    CAS  PubMed  Google Scholar 

  113. Maranzano E, Latini P, Beneventi S, et al. (1998) Comparison of two different kinds of radiotherapy schedules for spinal cord compression. Tumori 84:472–477

    CAS  PubMed  Google Scholar 

  114. Maranzano E, Latini P (1995) Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys 32:959–967

    Article  CAS  PubMed  Google Scholar 

  115. Maranzano E, Latini P, Perrucci E, Beneventi S, Lupattelli M, Corgna E (1997) Short-course radiotherapy (8 Gy ×2) in metastatic spinal cord compression: an effective and feasible treatment. Int J Radiat Oncol Biol Phys 38:1037–1044

    Article  CAS  PubMed  Google Scholar 

  116. Ghogawala Z, Mansfield FL, Borges LF (2001) Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine 26:818–824

    Article  CAS  PubMed  Google Scholar 

  117. Schiff D, Shaw EG, Cascino TL (1995) Outcome after spinal reirradiation for malignant epidural spinal cord compression. Ann Neurol 37:583–589

    CAS  PubMed  Google Scholar 

  118. Wong CS, Van Dyk J, Milosevic M, et al. (1994) Radiation myelopathy following single courses of radiotherapy and retreatment. Int J Radiat Oncol Biol Phys 30:197–202

    PubMed  Google Scholar 

  119. Loblaw DA, Smith K, Lockwood G, Carolan H, Laperriere NJ (2003) The Princess Margaret Hospital experience of malignant spinal cord compression. Proc ASCO

  120. Kim RY, Spencer SA (1990) Extradural spinal cord compression: analysis of factors determining functional prognosis—prospective study. Radiology 176:279–282

    CAS  PubMed  Google Scholar 

  121. Helwig-Larsen S, Sorensen PS, Kreiner S (2000) Prognostic factors in metastatic spinal cord compression: a prospective study using multivariate analysis of variables influencing survival and gait function in 153 patients. Int J Radiat Oncol Biol Phys 46:1163–1169

    PubMed  Google Scholar 

  122. Rades D, Heidenreich F, Karstens JH (2002) Final results of a prospective study of the prognostic value of the time to develop motor deficits before irradiation in metastatic spinal cord compression. Int J Radiat Oncol Biol Phys 53:975–979

    Article  PubMed  Google Scholar 

  123. Maranzano E, Latini P, et al. (1991) Radiation therapy in metastatic spinal cord compression. A prospective analysis of 105 consecutive patients. Ann Neurol 3:40–51

    Google Scholar 

  124. Maranzano E, Latini P, Beneventi S, et al. (1996) Radiotherapy without steroids in selected metastatic spinal cord compression patients. A phase II trial. Am J Clin Oncol 19:179–183

    Article  CAS  PubMed  Google Scholar 

  125. Ampil FL, Chin HW (1995) Radiotherapy alone for extradural compression by spinal myeloma. Radiat Med 13:129–131

    CAS  PubMed  Google Scholar 

  126. Kovner F, Spigel S, Rider I, et al. (1999) Radiation therapy of metastatic spinal cord compression. J Neurooncol 42:85–92

    Article  CAS  PubMed  Google Scholar 

  127. Greenberg HS, Kim JH, Posner JB (1980) Epidural spinal cord compression from metastatic tumor: results with a new treatment protocol. Ann Neurol 8:361–366

    CAS  PubMed  Google Scholar 

  128. Bubendorf L, Schopfer A, Wagner U, et al. (2000) Metastatic patterns of prostate cancer: an autopsy study of 1,589 patients. Hum Pathol 31:578–583

    CAS  PubMed  Google Scholar 

  129. Nakamachi H, Suzuki H, Akakura K, et al. (2003) Clinical significance of pulmonary metastases in stage D2 prostate cancer patients. Prostate Cancer Prostatic Dis 5:159–163

    Article  Google Scholar 

  130. McCutcheon IE, Eng DY, Logothetis CJ (1999) Brain metastasis from prostate carcinoma: antemortem recognition and outcome after treatment. Cancer 86:2301–2311

    Article  CAS  PubMed  Google Scholar 

  131. Rubenstein JH, Katin MJ, Mangano MM, et al. (1997) Small cell anaplastic carcinoma of the prostate: seven new cases, review of the literature, and discussion of a therapeutic strategy. Am J Clin Oncol 20:376–380

    Article  CAS  PubMed  Google Scholar 

  132. Fabozzi SJ, Schellhammer PF, el-Mahdi AM (1995) Pulmonary metastases from prostate cancer. Cancer 75:2706–2709

    CAS  PubMed  Google Scholar 

  133. Taylor HG, Lefkowitz M, Skoog SJ, et al. (1984) Intracranial metastases in prostate cancer. Cancer 53:2728–2730

    CAS  PubMed  Google Scholar 

  134. Sneed PK, Suh JH, Goetsch SJ, et al. (2002) A multi-institutional review of radiosurgery alone vs. radiosurgery with whole brain radiotherapy as the initial management of brain metastases. Int J Radiat Oncol Biol Phys 53:519–526

    Article  PubMed  Google Scholar 

  135. O'Neill BP, Iturria NJ, Link MJ, et al. (2003) A comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases. Int J Radiat Oncol Biol Phys 55:1169–1176

    Article  PubMed  Google Scholar 

  136. Perez CA, Cosmatos D, Garcia DM, Eisbruch A, Poulter CA (1993) Irradiation in relapsing carcinoma of the prostate. Cancer 71 [Suppl]:1110–1122

    Google Scholar 

  137. Leibel SA, Pajak TF, Massullo V, et al. (1987) A comparison of misonidazole sensitized radiation therapy to radiation therapy alone for the palliation of hepatic metastases: results of a Radiation Therapy Oncology Group randomized prospective trial. Int J Radiat Oncol Biol Phys 13:1057–1064

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Toronto Sunnybrook Regional Cancer Centre, 2075 Bayview Avenue, Toronto, ON M4 N 3M5, Canada

    Edward Chow & Andrew Loblaw

  2. Department of Radiation Oncology, Tom Baker Cancer Centre, 1331 29th St NW, Calgary, AB T2 N 4N2, Canada

    Jackson Wu

  3. Department of Radiation Oncology, Mallinckrodt Institute of Radiology, 4511 Forest Park Blvd, Ste 200, Saint Louis, MO 63108, USA

    Carlos A. Perez

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  1. Edward Chow
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  2. Jackson Wu
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  3. Andrew Loblaw
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  4. Carlos A. Perez
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Correspondence to Edward Chow.

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Chow, E., Wu, J., Loblaw, A. et al. Radiotherapeutic approaches to metastatic disease. World J Urol 21, 229–242 (2003). https://doi.org/10.1007/s00345-003-0359-7

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