Hypocalcemia Associated with Strontium-89 Administration in a Patient with Diffuse Bone Metastases from Neuroendocrine Carcinoma

Metastatic bone disease is often associated with severe pain in cancer patients, and has become an increasingly important quality-of-life issue. Radionuclides, such as strontium-89 (Sr-89), have provided effective palliation of metastatic bone pain. Although strontium follows the biochemical pathways of calcium in the body, changes in calcium homeostasis related to Sr-89 therapy have rarely been reported. We present a case of a 32-year-old male with poorly differentiated neuroendocrine carcinoma and extensive skeleton metastases who developed profound hypocalcemia after Sr-89 administration.     

The effectivness of strontium 89 in palliative therapy of painful prostate cancer bone metastases

Background. The aim of this study was to evaluate the effectivness of strontium 89 (Metastron) therapy in the group of prostate cancer patients with multiple bone metastases.
Material and methods. The study included 70 patients (aged 53-84) with prostate cancer and multiple bone painful metastases detected by scintigraphy and by radiogram character of metastases (osteoblastic - 55 patients, osteolytic-osteoblastic - 15 patients). Before strontium 89 therapy 34 out 70 patients have been performed local irradiation to the back bone as prevention of spinal cord compression. For assessment of therapy effectivness; pain relief (VAS scale), a reduction in analgesic requirements and motor activity (ECOG and Karnofsky scale) were evaluated.
Results. We conclude that palliative therapy using strontium 89 is effective (88% "good" and "moderate" response rate) and safe for bone pain palliation in patients with multiple prostate cancer bone metastases; it also improves the quality of life. We have observed that the analgesic requirments decreased to 50% of dose on average. The motor activity of the points evaluated according to ECOG scale and Karnofsky scale was much better (p < 0,05).     

Preliminary results of combined application of radioisotopes and biphosphonates in the management of pain associated with osteoblastic-osteolytic bone metastases of breast cancer

Background. The aim of this study was to evaluate the effectivness of connected therapy using strontium 89 or Sm153 (osteoblastic component) and bisphosphonate therapy (osteolytic component) in the group of breast cancer patients with multiple osteoblastic-osteolytic (mixt) bone metastases.
Material and methods. The study included 16 patients with breast cancer and multiple bone painful metastases detected by scintigraphy and by radiogram or CT or MRI (the type of metastases). Each patient received a standard dose of strontium 89 (Metastron) or samarium 153 (Quadramet) combined with intravenous infusion of pamidronate (Aredia) or zoledronate (Zometa). The bisphosphonate therapy was repeated every month. For assessment of therapy effectivness; pain relief (VAS scale), a reduction in analgesic requirements and motor activity (ECOG and Karnofsky scale) were evaluated. The group of 10 patients treated with bisphosphonate only in the same time was observed.
Results. We conclude that connected palliative therapy using strontium 89 and bisphosphonates is effective (66-75% "good" and "moderate" response rate) and safe for bone pain palliation in patients with multiple osteoblastic-osteolytic bone metastases from breast cancer. We have observed that the analgesic requirments decreased to 30% of dose on average. The motor activity of the points evaluated according to ECOG scale increased from 3 to 2 and from 50 to 60 to Karnofsky scale.
Conclusions. The results of treatment in the group with radioisotope and bisphosphonate were better than in the group treated with bisphosphonates or radioisotope only.     

Time of survival and quality of life of the patients operatively treated due to pathological fractures due to bone metastases

Background. Aims of the study: 1) evaluation of the quality of life of the patients after surgical treatment of bone metastases, 2) evaluation of survival rate of the patients after surgical treatment of bone metastases,
3) presentation of the authors' clinical score system for evaluation of the treatment results of bone metastases, 4) analysis of general complications rate after surgical treatment of bone metastases.
Material and methods. Retrospective evaluation of 62 patients with bone metastases treated operatively in our Ward during last 13 years was made. Mean age of patients was 63,6 years. There were 41 women (mean age; 62,8 years) and 21 men (mean age: 64,3). In 49 cases (79%) we were able to diagnose primary localization of the tumour: breast carcinoma - 22, ovary cancer - 6, lung cancer - 5, prostate cancer - 5, kidney cancer - 6, gastric cancer - 1, vaginal cancer - 1, hepatocellular cancer - 1, melanoma - 1 and plasmocytoma - 1. We could not reveal primary focus of the tumour in 13 cases (21%). Localizations of bone metastases are as follow: femur - 49 cases, humerus - 10, tibia - 3. After being accepted to operavite treatment, the patients had been cured as quickly as possible - sometimes during emergency service. In 2 cases with metastases in the tibia there were amputations made in femur regions. In remainq patients we made local excisions of metastatic tumours with internal osteosynthesis and bone cement application in 47 cases, with internal osteosynthesis only in 7 cases, with hip arthroplasty in 8 cases.
Results. We have poor results in 4,8%, because of the death of 3 patients. Mean time of follow-up since surgical procedure was 6 months. In 82,3% we have very good or good results - no pain, good function and independence in daily activities. Mean survival time is 17,5 months (range: 5-36 months).
Conclusions. Efficacy of the surgical procedures of pathological fracures due to bone metastases in reliving the pain, improvement of patients' mobility and activiteis of day living are very good. Mean time of survival after surgical treatment of pathological fracture due to bone metastases in study group justifies its applications in spite of higher rate of general complications.
     

Clinical and radiographic evaluation of mechanical sufficiency of the operative treatment of pathological fractures in bone metastases

Background. Aims: Retrospective evaluation of mechanical sufficiency of applied surgical methods of bone metastases treatment according to authors' own scoring system.
Material and methods. 60 patients with bone metastases treated operatively in our Ward during 1989-2002. Mean age of patients was 62,5 years old. There were 39 women and 21 men. In 48 cases (80%) there were possible to diagnose primary localization of the tumor. We could not reveal primary focus of the tumor in 10 cases (20%). Localizations of bone metastases are as follow: femur - 49 cases, humerus - 10 cases, tibia - 1 case.
After local excision of metastatic tumor had been done the internal osteosynthesis and bone cement application was made in 45 cases, the internal osteosynthesis only was made in 7 cases, hip arthroplasty was made in 8 cases. Mean time of follow-up since surgical procedure was 8 months. Scoring system for radiographic and clinical evaluation of mechanical efficacy of operative fixation of pathologic fractures: grade I - good mechanical fixation, grade II - minimal loss of fixation, grade III - poor mechanical fixation, grade IV - relapse of pathological fracture.
Results. We had poor results in 5%, because of the death of 3 patients. In 58 cases (97%) we had very good or good results - no pain, good function and independence in daily activities (grade I and II in scoring system of mechanical efficacy of pathologic fracture fixation). In remaining 2 patients (3%) there was loss of mechanically stabile fixation of pathological fracture.
Conclusions. 1. Mechanical efficacy of the fixation of pathological fractures is good and lasting in 97% of cases. 2. Local complications rate was 2% and was due to mechanical unstabile fixation of pathological fracture.     

The efficacy analysis of partial bone resection procedure in pathological fractures treatment (own experience)

Background. The objective of this paper is efficacy assesment of partial bone resection procedure with subsequent joint exchange as a method of skeletal cancer metastases and pathological fractures surgical treatment within hip and shoulder among patients in our own experience.
Material and methods. 79 patients operated between 1997 and 2002 were assesed.Group I - 68 cases with sceletal cancer metastases and pathological fracture of proximal femur.Group II - 11 patients with sceletal cancer metastases and pathological fracture of humerus.The patients underwent primary or secondary (after complications) partial resection procedure with subsequent joint prosthesis implantation.The range of femur resection was 6-17cm.Various types of total or partial hip and shoulder joint endoprostheses according to indication were used.Additional paliative radiotherapy of mathastases,bisphosphonians and analgetics were used according to the case.The average follow-up period was 9,6 months (0-3y). The efficacy analysis was based on Enneking limb function test and Merle d'Aubigne classification and X-ray analysis in patients with partial proximal femur resection.
Results. Group I-according to Enneking test in 41 patients very good and good results,fair in 22 and bad only in 5 cases were found.According to Merle'd Aubigne classification in 37 cases very good and good outcome was found.In 25 the outcome was fair and bad in 6 patients.The machanical instability complication assesed radiologically were found in 7 patients.
Conclusions. The partial bone resection with subsequent joint exchange procedure is positively assesed in patients subjective opinion and its high rate of very good and good results let us conclude this kind of surgery as a very good method in some types of pathological fracture treatment.However a massive bone and particullary soft tissue resection may produce higher incidence of mechanical complications - especially dislocations.     

The own experience in femoral bone metastases treatment

Background. The objective of this paper is an efficacy analysis of surgical treatment of femoral bone cancer metasases depending on surgical technique and tumor localisation.
Material and methods. 144 patients who underwent surgery in 1996-2002 were assesed. In 32 patients with proximal femur matastases tumor resection and angled plate stabilisation was made, 68 patients underwent THR.
In 20 patients with tumor situated in femoral shaft an intramedullary nailing was performed and the rest 14 patients were treated with plate (AO/ASIF) technique. In 10 patients with distal femoral metastases an angled condylar plate was used.The average follow-up time was 6 months.
Results. The surgery outcome was assesed by functional Enneking test. The cases with proximal femur metastases were assesed by Merle d'Aubigne classification. In cases after resection and subsequent THR very good results were found in 5 patients,good in 34, fair in 23 and bad in 6 patients according to Enneking scale. In Merle d'Aubigne classification the results were as follows:very good in 6, good in 30, fair in 26 and bad in 6 patients.
In the intramedullary nailing group the limb function was found good in 17, in 1 fair and bad in 2 patients. The limb function in patients who were operated using plate condylar or stright(AO/ASIF) plate technique was found fair.
Conclusions. The high patients satisfaction and high ratio of good and very good results in tests after modular THR(proximal femur metastases)and after intramedullary nailing(femoral shaft pathology)are methods of choice in those cases. AO plate stabilisation combined with bone cement augmentation is suitable for pathological fractures management.     

Palliation of bone pain in prostate cancer using chemotherapy and strontium-89. A randomized phase II study

Strontium-89 is an established alternative for the alleviation of bone pain in prostate cancer. There are few data evaluating the effect on pain of palliative chemotherapy. The aim of this randomized phase II study was to assess and compare the analgesic efficacy of strontium-89 and chemotherapy (FEM=5-FU, epirubicin, and mitomycin C) in 35 patients with disseminated, hormone-refractory prostate cancer suffering from persisting bone pain despite analgesic treatment. In order to minimize the risk for imbalances regarding the two patient groups, a double-blind randomization was performed. A significant reduction in pain intensity and pain frequency was registered in both patient groups (P < 0.01 in both groups after 3 weeks). Side effects were generally mild in the strontium-89 group and significantly more severe in the FEM group. The effect of FEM on pain is surprising as chemotherapy has generally only limited effect on tumor growth in bone metastases due to prostate cancer. A possible explanation is that FEM has an inhibitory activity on the inflammatory component of metastases.     

The impact of bisphosphonate therapy on the survival time of patients undergoing radiotherapy for bone metastases

Background. Bisphosphonates are form of medical therapy for bone metastases. Morbidity from bone metastases including hypercalcemia episodes, pain, pathological fractures and appearance of new metastases in skeletal system is decreased by bisphosphonate therapy. The aim of this article is to determine the influence of bisphosphonate therapy on survival time of patients irradiated due to bone metastases.
Material and methods. 305 patients irradiated due to bone metastases were assessed in this retrospective study. 94 of them were additional treated by bisphosphonates. Median survival time counted from the end of radiotherapy to the death of patients was assessed. Using U Mann Whitney test the influence of bisphosphonates therapy on survival time was determined. The significance level of p = 0,05 was accepted.
Results. The median survival time of patients irradiated due to bone metastases and treated by bisphosphonates was 8,1 month and 5,24 month in the group treated only by radiotherapy. Median survival time of pts with breast cancer and with unknown primary site of cancer who were treated by radiotherapy and bisphosphonates was significantly longer (respectively p = 0,001 and p = 0,016) as compared with the group with irradiated bone metastases only.
Conclusions. 1. Bisphosphonates therapy improved the median survival time in the whole group of patients irradiated due to bone metastases. 2. Statisticaly significant prolonged survival time was observed in groups of patients with breast cancer and with unknown primary site of cancer. Median survival time was prolonged in these groups about 5 months and 3,5 months respectively.     

Prostate cancer in the late 1990s: hormone refractory disease options

Prostate cancer is the most common tumor and second most common cause of cancer death in American men. Advanced prostate cancer patients commonly have painful skeletal bony metastases. Although hormonal therapy is very effective initially, hormone-refractory prostate cancer may be associated with bone pain and other symptoms such as urinary obstruction. Aside from oral and parenteral non-narcotic and narcotic medications, several recent FDA-approved outpatient medications are effective for palliation of painful bony metastases. Mitoxantrone chemotherapy in combination with glucocorticoids and the radioisotopes strontium-89 and samarium-153-lexidronam are now available. Urologic nursing personnel should be familiar with these new and complementary modalities.     

Radiotherapy of skeletal metastases

Radiotherapy plays an important role in treatment of bone metastases.
The mayor problem associated with bone metastases is pain, pathological fractures and a spinal cord compression. Radiotherapy is employed as a palliative treatment, mainly to relieve pain.
1.Radiotherapy with a single dose of 5-8 Gy/T is an efficient method of pain management especially in patients with bone metastases outside the vertebral column. This treatment can be provided as a day procedure.
2.Multi-fractionated irradiation - patients receive 20 Gy/T in 5 fractions or 30 Gy/T in 10 fractions. This is advocated for patients with metastases in the vertebral column or bones of the pelvis.
3.Half- body irradiation is designed for patients with multiple bone metastases. It's a single dose treatment. The upper half of body is irradiated with a dose of 6 Gy/T, the lower part with a dose of 8 Gy/T. Patients need a special preparation beforehand (steroids, hydratation) and hospitalization afterwards.     

Fixation of pathological fractures and impending long bone fractures in the course of neoplastic disease with the use of polymethylmethacrylate with added methotrexate

Background. The authors present the results of operative treatment in 71 patients with pathological fractures and impending long bone fractures resulting from neoplastic metastases.
Materials and methods. The discussed group of patients consists of 43 women and 28 men aged 36 to 80 years, the follow-up period is 6 to 48 months. After resection the metastatic focus was filled with cement supplemented with 2g methotrexate and stabilised with AO plate or a hip endoprosthesis was set up.
Results. In 37 operated patients the pain subsided completely or markedly eased, 13 patients periodically required non-narcotic analgesics, and in 19 the pain did not subside.
The treatment applied allowed all the patients with fractures within the lower extremities to abandon the bed and to move with the aid of crutches., and in 17 with fractures of the humerus it enabled the performance of daily living and self-care activities. Within the discussed group 9 patients with multiple metastases to the lungs and to the vertebral column died after average of 12 months. The longest survival period was observed in patients with metastases of renal cancer - average of 42 months, breast cancer - 37 months and ovary cancer - 29 months. No postoperative complications were observed; in 2 patients after 8 and 10 weeks destabilisation of the fixation intervened as a result of intensive weight-bearing without the aid of crutches.
Conclusions. Filling the metastatic bone defect with methotrexate supplemented cement and stable fixation of a pathological fracture or an impending fracture enables movement, performance of daily living activities, eases or clears pain completely, improves the comfort of life, facilitates patient care and it may be an element of complex treatment of pathological and impending fractures in the course of neoplastic disease.     

The surgical manegement of metastases to humerus-clinical evaluation

Background. The humerus is a common localisation of cancer metastases. The restoration of anatomical order and tumor resection within humerus is important for patients quality of everyday life and for their pain relief. The surgical treatment is one of the most important part of the whole oncological ways of tratment.
The study objective was a clinical assesment of tumor resection and reconstruction within humerus according to matastasis localisation and the choice of surgical technique.
Material and methods. In the years 1999-2002 19 patients underwent surgery due to pathological fracture or/and cancer metastasis within humerus. The shaft localisation of the tumor was found in 8 cases and in 11 patients the metastatic foci were found in proximnal diaphysis. In patients with proximal diaphysis localisation of the tumor the partial resection with subsequent joint exchange procedure was made. The humeral shaft metastatic cancer changes were treated by the segmental resection with subsequent surgical cement filling or auto/allogenical bone grafting combined with intramedullary nail or AO/ASIF plate stabilisation. The average follow-up period was 8,5 months.
Results. In patients after resection with shoulder joint alloplasty according to the Enneking test a very good result was found in 7 and very good in 4 cases.
In patients with femoral shaft metastatic tumor locaslisation, 6 good and 2 fair results were found. In 1 patient after 2 months rehabilitation a reoperation was needed due to the mechanical destabilisation. The best results were found in patients after intramedullary nailing.An acute soft tissue inflamation requiering surgical treatment was found in 1 patient after shoulder joint replacement.
Conclusions. After clinical analysis of the material we highly recomend the partial humeral bone resection with subsequent shoulder alloplasty in patients with proximal humeral diaphysis metastatic localisation. In cases with shaft localisation a better results were found after intramedullary nailing compared to common plate technique.     

放射性核素89Sr治疗骨转移癌引起骨痛的疗效分析

目的探讨放射性核素89Sr控制骨转移癌引起骨痛的作用。方法选择伴有骨痛的32例骨转移病人,静脉推注89SrCl2,剂量为4mCi/人。结果疼痛缓解总有效率78%(25/32),无效率12·5%(4/32)。结论89Sr治疗能明显缓解骨痛,改善患者的生活质量,有重要的临床意义。     

CellSearch检测循环肿瘤细胞对转移性乳腺癌预后的Meta分析

目的系统性评价CellSearch检测循环肿瘤细胞在转移性乳腺癌患者预后中的作用。方法检索PubMed、EMbase、Cochrane图书馆、中国期刊全文数据库(CNKI)及中国生物医学文献数据库(CBM)等,收集CellSearch检测循环肿瘤细胞(CTCs)对转移性乳腺癌患者预后的研究。以无进展生存期(PFS)和总生期(OS)为观察终点,ReviewManager5.1进行Meta分析。结果19篇英文文献包含3710例转移性乳腺癌患者纳入荟萃分析,分析结果显示CTCs阳性组与肿瘤转移灶数目增加呈强相关(OR=1.53,95%CI:1.26¹.85)。与肿瘤原发灶HER2+(OR=1.15,95%CI:0.621.85)。与肿瘤原发灶HER2+(OR=1.15,95%CI:0.62².13),肿瘤分级(OR=1.68,95%CI:0.552.13),肿瘤分级(OR=1.68,95%CI:0.55⁵.14),肿瘤治疗(OR=0.89,95%CI:0.725.14),肿瘤治疗(OR=0.89,95%CI:0.72¹.11)无相关性。CTC阳性组较阴性组在PFS(HR=1.67,95%CI:1.441.11)无相关性。CTC阳性组较阴性组在PFS(HR=1.67,95%CI:1.44¹.92)、OS(HR=2.80,95%CI:2.321.92)、OS(HR=2.80,95%CI:2.32³.37)上均有统计学意义(P<0.05),根据不同的标本采集时间进行亚组分析,CTC阳性组均比CTC阴性患者预后差。结论CellSearch System检测CTCs用来预测转移性乳腺癌患者预后,其中,CTC阳性组是肿瘤的转移的风险因素,基线及治疗前CTC阳性组均预示转移性乳腺癌患者预后不良,敏感性分析和漏斗图分析结果提示该研究结果可信度高。     

Complications after surgical treatment of bone metastases to proximal femur

Background. Bone metastases in proximal femur a frequently treated surgically.
Material and methods. The authors present complications in the operative treatment of bone metastases to proximal femur in 82 patients managed at the Departament of Orthopedics and Traumatology of the Lublin University of Medical Sciences between 1978 and 2002.
Results. Recidives, angulated plates fractures, endoprostheses luxations and deep infections complicated 20% of the procedures. Revision surgery restored good function of painless limbs. Poor results were noted in
3 patients with deep infections of the endoprostheses.
Conclusions. Recidives, angulated plates fractures and endoprosthesis luxations can be avoided by large resections of the tumor and reconstruction with bipolar postresection endoprosthesoplasty.     

Avoidance of colostomy placement in advanced colorectal cancer with twice weekly hypofractionated radiation plus continuous infusion 5-fluorouracil

The purpose of this study was to determine the efficacy of twice weekly hypo-fractionated radiation therapy (RT) plus continuous infusion 5-fluorouracil for unresectable or locally advanced colorectal cancer with synchronous metastases. Palliative radiation consisting of 30 Gy/6 fractions/3 weeks was administered to 87 patients from 1982-1995 with 3 field belly board technique. Diverting colostomy was required for obstruction in 14 (16%) prior to radiation; 47 patients (54%) had recurrent disease following prior resection and 58 (66%) had distant metastases on presentation. Median follow-up was 12 months (1-104 months). Stabilization/regression of pelvic disease was accomplished in 65 patients (75%). Complete resection of the pelvic disease was accomplished in 5 patients (6%), all of whom had synchronous metastases. Diverting colostomy was required in only 11 patients after chemoradiation because of progressive pelvic tumor; 2 of these 11 patients (18%) had isolated progression of pelvic disease. Overall, colostomy was not required in 48 of the 72 patients (67%) who did not present with a stoma. Median survival was 11 months if metastatic disease was present and only 6 months when disease was limited to the pelvis. Grade 3 acute radiation toxicities occurred in <10% and no grade 4 acute toxicities were observed. No significant late radiation effects were noted. Twice weekly hypofractionated RT is well tolerated and provides durable palliation of symptoms related to locally advanced primary or recurrent colorectal cancer with metastatic disease.     

初诊无远处转移的穿刺病理Gleason评分10分前列腺癌的临床特点

  目的  分析初诊无远处转移的穿刺病理Gleason评分为10分前列腺癌的临床特点并探讨外放疗联合内分泌治疗的疗效。  方法  2003年1月至2014年3月北京协和医院收治初诊无远处转移的Gleason评分10分前列腺癌患者9例。所有患者均接受全盆腔外放疗联合长期内分泌治疗。全盆腔外放疗的照射剂量为50.0 Gy, 前列腺、双侧精囊腺及区域阳性淋巴结加量至76.2~78.0 Gy。内分泌治疗采用最大限度雄激素阻断:口服抗雄激素药物加每月注射一次黄体生成素释放激素类似物。分析患者临床特点及联合治疗效果, 并运用Kaplan-Meier法绘制生存曲线。  结果  患者中位随访时间为4.8年(26~75个月)。治疗前中位血清前列腺特异性抗原(prostate specific antigen, PSA)为11.2 μg/L, 其中6例低于20 μg/L, 3例高于70 μg/L。中位穿刺活检针数阳性率为90.9%。TNM分期:3例T_2c, 4例T_3a, 2例T_3b; 6例N₀, 3例N₁; 9例M₀。随访期间, 6例患者出现生化复发, 其中5例进一步发展为转移性前列腺癌; 4例患者死亡, 其中3例死于前列腺癌。5年无生化复发率、无远处转移率、肿瘤特异性生存率及总体生存率分别为28.6%、57.1%、66.7%和57.1%。5例出现1~2级早期放疗胃肠道不良反应, 6例出现1~2级早期泌尿系统不良反应, 无晚期胃肠道及泌尿系统不良反应。无骨折、心血管意外等严重内分泌治疗并发症。  结论  初诊无远处转移的穿刺病理Gleason评分10分前列腺癌常伴穿刺阳性范围大、肿瘤分期偏晚等高危因素, 患者通常预后不良, 放疗联合内分泌治疗等及时和积极的综合治疗方案往往是必需的。     

Serum CA 125 levels and lymph node metastasis in patients with endometrial cancer

The aim of this study was to evaluate the correlation of preoperative serum CA 125 levels and lymph node metastasis in patients with endometrial cancer. Preoperative levels of serum CA 125 were determined in 64 patients with endometrial cancer treated with total abdominal hysterectomy with a lymph node dissection as initial therapy. Lymph node status, determined by histopathology, was correlated with both normal and elevated CA 125 levels, determined preoperatively. A serum CA 125 level of >30 IU/ml was considered elevated. There were five patients (7.8%) with pelvic or paraaortic lymph node metastases and 59 patients (92.2%) without nodal metastases. In all five patients with lymph node metastases, serum CA 125 was within normal limits. Preoperative serum CA 125 levels were above normal in eight lymph node-negative patients. In the remaining group of 51 node-negative patients, serum CA 125 levels were within normal limits. Among the five lymph node-positive patients, four had endometrioid and one had serous papillary cancer. One patient had histologic grade 2 tumor and four patients had histologic grade 3. Preoperative serum CA 125 levels do not offer any information for predicting lymph node metastasis in patients with endometrial cancer.     

Palliative radiotherapy in the treatment of skeletal metastases.

Two-third of patients with metastatic cancer suffer from pain. Pain originating from skeletal metastases is the most common form of cancer pain. Bone pain, often exacerbated by pressure or movement, limits the patient's autonomy and social life. Pathological fracture and spinal cord compression are additional complications caused by bone metastases.Radiotherapy is effective in treating bone pain not adequately controlled by analgesics. Seventy percent of patients benefit from radiotherapy. Single and multifraction regimens are equally effective in relieving pain. Retreatment is needed somewhat more often following single fraction therapy. Most patients benefit from retreatment irrespectively of previous fractionation schedule. Hemibody irradiation and radioisotopes, e.g., strontium-89 and samarium-153 are used in treating scattered painful bone metastases.Radiotherapy is used for preventing pathological fracture by treating osteolytic lesions especially in the weight-bearing bones such as the spinal column and long bones.Radiotherapy is the treatment of choice in spinal cord compression, which is the most serious complication caused by bone secondaries.Radiotherapy provides efficient, well-tolerated and cost-effective palliative care.