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The Role of Radiotherapy in Long Bone Metastases and Pelvis

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Management of Bone Metastases

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Abstract

Bone metastases are a common complication of advanced cancer that can cause severe and debilitating effects. External beam radiation therapy (EBRT) provides significant palliation of painful bone metastases in around 70% of patients, induces remineralization, prevents impending fractures, and promotes healing of pathological fractures, reducing the skeletal-related events (SRE). Hypofractionated schedules are used for the treatment of bone metastases; the most commonly used are a single 8 Gy, 20 Gy in five daily treatments (4 Gy per treatment), and 30 Gy in ten daily treatments (3 Gy per treatment). Postoperative external beam irradiation can significantly reduce disease progression and subsequent loss of fixation. In the postoperative setting, the treatment field should include the entire interlocking device, nails, or prosthesis in order to remove any microscopic dissemination of disease. Two-dimensional or 3D conformal radiotherapy could be used for treatment planning. Simple field assessment (anteroposterior-posteroanterior AP-PA field) is often used for treatment planning of long bones, leading to a shorter treatment time. For pelvic bone metastases, a more complex field assessment could be considered to lessen the dose to the organs at risk, leading to a better tolerability of the treatment itself. Recent technological advances, such as intensity-modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT), can be used in a particular setting of oligometastatic patients to deliver a substantial dose of radiation to the tumor and spare healthy normal tissues.

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Authors and Affiliations

  1. Radioterapia Oncologica, Università Campus Biomedico, Rome, Italy

    Michele Fiore, Carla Germana Rinaldi & Sara Ramella

Authors
  1. Michele Fiore
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  2. Carla Germana Rinaldi
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  3. Sara Ramella
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Correspondence to Sara Ramella .

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Editors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Rome, Italy

    Vincenzo Denaro

  2. Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Rome, Italy

    Alberto Di Martino

  3. General Direction of Health Program, National Ministry of Health of Italy, Rome, Italy

    Andrea Piccioli

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Fiore, M., Rinaldi, C.G., Ramella, S. (2019). The Role of Radiotherapy in Long Bone Metastases and Pelvis. In: Denaro, V., Di Martino, A., Piccioli, A. (eds) Management of Bone Metastases. Springer, Cham. https://doi.org/10.1007/978-3-319-73485-9_6

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  • DOI: https://doi.org/10.1007/978-3-319-73485-9_6

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  • Online ISBN: 978-3-319-73485-9

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