Bone Metastases

Bone metastases are a common clinical problem that is associated with the potential for significant symptoms such as pain, pathologic fracture, spinal cord compression, and hypercalcemia. A variety of palliative treatment modalities is available for bone metastases ranging from local to systemic, and from non-invasive to invasive. The majority of treatments are directed towards optimum palliation with minimum treatment related morbidity. For localized bone pain and for pain with a radiating component, neuropathic pain, radiotherapy is considered the standard treatment modality. The chapter presents data coming from pooled results arising from the results of numerous randomized clinical trials. Proper management of painful bone metastases requires well-coordinated, multi-disciplinary care that honors palliative care principles and seeks to maximize quality of life. Finally, the chapter describes an algorithm for use of palliative radiotherapy for patients with bone metastases.