Bone Metastases

Bone Metastases

Cancers that originate at another site (usually breast, prostate or lung) that spread to the bone are called bone metastases

Skeleton

Spine

Vertebrae

The bones in the spine are numbered

7 cervical

12 thoracic

5 lumbar

5 sacral

Spinal cord ends at T12-L1

Bone cancer in the spine can create problems if the tumor compresses the spinal cord inside the neural canal

Pain symptoms are related to the spot in the spine involved

MRI Spinal Metastases from Lung Cancer

The mets toL3 caused backPain radiatingInto the legs

MRI of the Lumbar Spine with Bone Destruction of L3 from Lymphoma

Bone Metastases

Origin: most common sites of origin (primary) are lung, breast, prostate and kidney

Symptoms: pain (esp at night), possible fracture or nerve compression , may cause elevated calcium level or lead to anemia

ribs

spine

pelvis

femurs

Most common sites for bone

metastases

Some bone mets make the bone look too white (osteoblastic)

others make dark holes (lytic)

Lytic = black hole in the bone

Blastic = abnormal white area

If not treated, lytic bone mets can cause considerable bone destruction

If the cancer has weakened the bone, it may be necessary to perform surgery prior to radiation to avoid a fracture

Blastic Bone Mets as seen on a CT scan

An MRI may show a bone met better than a regular X-ray

Bone Scan

A nuclear medicine (technitium) bone scan would show bone mets as dark areas

CT Scans show good bone detail

PET scans may show bone mets very clearly

PET Scans can be used to help targetthe radiation three dimensionally

PET showing the cancer pushing into the back of the right hip bone

Computer generated reconstruction showing the cancer in red and the radiation zone in orange

Bone met at L2

Radiation field

A typical course of radiation is 10 treatments ( in some cases it is necessary to go slower, 20 to 25 trips)

Side Effects of Radiation for Bone mets

•Mild fatigue

•Local skin irritation

•Lower the blood count (anemia or white count)

•The bone can temporarily get weaker before strengthening

Local Side Effects of Radiation for Bone mets

Sore throat or dry mouth

Trouble swallowing , heart burn or dry cough

Loose bowels or cramps

Bladder or rectal irritation

Radiation Results

•80 - 90% of the time the symptoms improve

•Complete relief in 54%

•Most respond by 10-14 days, 70% by 2 weeks, 90% by 3 months

•55 - 70% pain benefit is sustained for life

Can You Radiate a Bone Metastasis a second time if the cancer flares up?

Effectiveness of Reirradiation for Painful Bone Metastases: A Systematic Review and Meta-Analysis (IJROBP 2012:84:8)

Of the 2,694 patients initially treated for metastatic bone pain, 527 (20%) patients underwent reirradiation.

Overall, a pain response after reirradiation was achieved in 58% of patients

Xrays may take weeks to months to show improvement

PET scans can show response to radiationH&N squamous mets to L4

Before XRT 3 months after XRT

Same patient at 7 months, PET scan now totally back to normal

As the cancer shrinks (gray tissue) the bone can regrow

Bone Metastases to the Spine

Involved vertebrae on the left and normal on the right

Kidney cancer in the spinal vertebrae surrounding the cord, and appearance after radiation…is it possible to safely radiate further?

Radiation prescription for #

Diagnosis: #

Area Treated: #

Number of Treatments: #