Рентгенология & Радиология, 2013, LII 12-19

Radiation and metabolic therapy in bone metastases

  1. Parvanova, L. Chavdarova, E. Piperkova, D. Kazarov

Pain palliation in bone metastatic disease includes application of analgetics, steroids, dedicated antitumor drugs, iphosphonates and radionuclides (metabolic therapy), and as local methods – radiotherapy coupled in selected cases with surgery. Radiotherapy has a specific efficacy in reducing pain in 70-80% of patients with bone metastases and in 50- 70% of those with spinal cord compression. The analgesic local effect is essential, it is cheap and achieved quickly but bone marrow toxicity may limit the number of sites that can be treated Radionuclide therapy irradiates all the painful sites with a single treatment. The use of radionuclides has a systemic character achieving near excellent pain relief in 45- 80% of patients and a complete response in 10-30%. Patients’ mobility and quality of life get improved and their dependence of non-narcotic and narcotic drugs reduces. Regardless of existing algorithms there are still a lot of unsolved problems about the sequence of methods for local and systemic treatment, optimization of radionuclide therapy, combination of biphosphonates, denosumab and cisplatin, overall survival and the delay of bone metastatic complications stay under discussion.