Bone metastases (BM) are a common complication in advanced cancer patients, significantly contributing to morbidity and mortality due to their ability to cause pain, fractures, and spinal cord compression. Radiation therapy (RT) is vital in managing these complications by targeting metastatic lesions to ease pain, improve mobility, and reduce the risk of skeletal-related events such as fractures. Evidence supports the effectiveness of RT in pain relief, showing its ability to provide significant palliation and lessen the need for opioid painkillers, thereby enhancing the overall quality of life (QoL) for patients with BM. However, optimizing RT outcomes involves considerations such as the choice of radiation technique, dose fractionation schedules, and the integration of supportive care measures to mitigate treatment-related side effects like fatigue and skin reactions. These factors highlight the importance of personalized treatment planning tailored to individual patient needs and tumor characteristics. This mini-review aims to provide comprehensive insights into the multifaceted impacts of RT on pain management and QoL enhancement in BM patients, with implications for refining clinical practices and advancing patient care through the synthesis of findings from various studies.

• Radiation therapy
• Radiotherapy
• Quality of life
• Pain relief
• Bone metastases
• Bone cancer

• Bone metastasis
• Facteurs de pronostic
• Métastase osseuse
• Overall survival
• Palliation
• Prognostic factors
• Radiotherapy
• Radiothérapie
• Survie globale

• Humans
• Male
• Bone Neoplasms/secondary
• Bone Neoplasms/radiotherapy
• Bone Neoplasms/mortality
• Female
• Palliative Care
• Prognosis
• Aged
• Middle Aged
• Prospective Studies
• Aged, 80 and over
• Karnofsky Performance Status
• Adult
• Lung Neoplasms/radiotherapy
• Lung Neoplasms/mortality
• Lung Neoplasms/pathology
• Prostatic Neoplasms/radiotherapy
• Prostatic Neoplasms/pathology
• Prostatic Neoplasms/mortality
• Morphine/therapeutic use
• Breast Neoplasms/pathology
• Breast Neoplasms/radiotherapy
• Breast Neoplasms/mortality
• Kaplan-Meier Estimate
• Sex Factors
• Analgesics, Opioid/therapeutic use

• MRI
• Neoplasm metastasis
• Prognosis
• Radiosurgery

Objective: This study aimed to investigate the association between overall survival (OS) and activities of daily living (ADL) in patients with skeletal-related events. In this study, 265 patients whose clinical parameters were available before radiotherapy were investigated. Methods: Age, sex, ADL, pain, the primary site, spinal level of bone metastases, spinal instability, treatment strategy, including chemotherapy or palliative treatment, and OS were investigated. ADL patients with a Barthel index of ≥90 were classified as the high ADL group, while those with a score < 90 were classified as the low ADL group. For OS, patients surviving ≥160 days were classified as the non-poor prognosis group, and those who survived <160 days were classified as the poor prognosis group. Results: Age, sex, ADL, pain, the primary site, and treatment strategy for OS were different between the two groups (p < 0.1). Logistic regression analysis revealed that ADL, the primary site, and treatment strategy were significant predictors of OS (p < 0.05). High ADL, breast cancer, and chemotherapy had a positive effect on OS. Conclusions: It is suggested that improvements may be obtained by performing rehabilitation interventions to maintain and improve ADL, by constructing a system for monitoring spinal bone metastases with images before ADL decreases, and by performing interventions such as changes in treatment methods such as RT or surgery at appropriate times.

• health-related quality of life (HRQOL)
• oligometastases
• polymetastases
• spine
• survival
• tumor

To evaluate the potential role of ¹⁸F-fluorodeoxyglucose-positron emission tomography/computerized tomography (FDG-PET/CT) for predicting treatment response after radiotherapy (RT) in patients with spinal metastases.

A retrospective analysis was performed of 42 patients with spinal metastases who received RT from January 2010 to December 2014. All patients underwent FDG-PET/CT before and after treatment. Changes in metabolic responses, expressed as the maximum, mean, peak standardized uptake values (SUVmax, SUVmean, SUVpeak), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were analyzed to determine their association with clinical outcomes.

The median age at the time of spinal metastasis diagnosis was 58 years. Median progression-free survival (PFS) and overall survival after RT were 15 months and 22.4 months, respectively. RT produced a significant decrease in SUVmean (2.27 to 1.41), SUVmax (6.87 to 2.99), SUVpeak (5.75 to 2.33) and TLG (52.84 to 24.17) when compared with the baseline values (p<0.001). The mean pain score decreased from 3.86 before RT to 0.79 after RT (p<0.001). There were significant linear relationships between maximum SUV and pain scores at baseline (r = 0.321, p = 0.038) and after treatment (r = 0.369, p = 0.016) as well as TLG at baseline (r = 0.428, p = 0.005) and after treatment (r = 0.403, p = 0.009). Local progression after treatment was identified in 12 patients (28.6%). Univariate analyses showed that >70% reduction in maximum SUV after treatment was independently associated with good PFS (p = 0.036).

RT is an effective treatment for patients with spinal metastases, and there were significant changes in PET parameters compared with baseline. The metabolic response measured by SUV and TLG changes in FDG-PET/CT correlated with the clinical outcomes, especially with shorter PFS in patients who had higher residual maximum SUV after treatment.

• HRQoL
• MESCC
• SRS
• separation surgery
• spine tumor

• Pain
• Radiotherapy
• SINS
• Spine instability neoplastic score
• Spine metastasis

• Adult
• Aged
• Aged, 80 and over
• Bone Neoplasms/radiotherapy
• Bone Neoplasms/secondary
• Female
• Follow-Up Studies
• Humans
• Joint Instability/etiology
• Male
• Middle Aged
• Pain Management
• Palliative Care
• Prognosis
• Radiotherapy, Conformal/adverse effects
• Severity of Illness Index
• Spinal Neoplasms/pathology
• Spinal Neoplasms/radiotherapy

To compare the effects of resistance training versus passive physical therapy on bone survival in the metastatic bone during radiation therapy (RT) as combined treatment in patients with spinal bone metastases. Secondly, to evaluate overall survival and progression-free-survival (PFS) as well as to quantify prognostic factors of bone survival after combined treatment.

In this randomized trial 60 patients were allocated from September 2011 until March 2013 into one of the two groups: resistance training (group A) or passive physical therapy (group B) with thirty patients in each group during RT. We estimated patient survival using Kaplan-Meier survival method. The Wald-test was used to evaluate the prognostic importance of pathological fracture, primary site, Karnofsky performance status, localization of metastases, number of metastases, and cerebral metastases.

Median follow-up was 10 months (range 2–35). Bone survival showed no significant difference between groups (p = .303). Additionally no difference between groups could be detected in overall survival (p = .688) and PFS (p = .295). Local bone progression was detected in 16.7 % in group B, no irradiated bone in group A showed a local progression over the course (p = 0.019). In univariate analysis breast cancer, prostate cancer, and the presence of cerebral metastases had a significant impact on bone survival in group B, while no impact could be demonstrated in group A.

In this group of patients with spinal bone metastases we were able to show that guided resistance training of the paravertebral muscles had no essential impact on survival concomitant to RT. Importantly, no local bone progression in group A was detected, nevertheless no prognostic factor for combined treatment could be evaluated.

Clinical trial identifier NCT 01409720. Registered 8 February 2011.

• Bone metastases
• Palliative radiotherapy
• Resistance training
• Spine
• Survival

• pain flare
• palliative radiotherapy
• bone metastases

• Aged
• Aged, 80 and over
• Bone Neoplasms/complications
• Bone Neoplasms/therapy
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Metastasis/radiotherapy
• Pain/radiotherapy
• Palliative Care
• Prospective Studies
• Radiotherapy/adverse effects
• Radiotherapy/methods

To investigate the quality of life (QOL) following palliative radiotherapy for painful bone metastases.

A literature search was conducted in OvidSP Medline (1946–Jan Week 4 2014), Embase (1947–Week 5 2014), and the Cochrane Central Register of Controlled Trials (Dec 2013) databases. The search was limited to English. Subject headings and keywords included ‘palliative radiation’, ‘cancer palliative therapy’, ‘bone metastases’, ‘quality of life’, and ‘pain’. All studies (prospective or retrospective) reporting change in QOL before and after palliative radiotherapy for painful bone metastases were included.

Eighteen articles were selected from a total of 1730. The most commonly used tool to evaluate QOL was the Brief Pain Inventory. Seventeen studies collected data prospectively. An improvement in symptoms and functional interference scores following radiotherapy was observed in all studies. The difference in changes in QOL between responders and non responders was inconsistently reported.

QOL improves in patients who respond to palliative radiotherapy for painful bone metastases.

• Advanced cancer
• Bone metastases
• Quality of life
• Radiation therapy

Palliative radiotherapy (prt) is a routine part of oncology care in adult patients, but it is used much less frequently among children with incurable cancer. We surveyed Canadian pediatric oncologists to learn about their knowledge and use of prt and to identify potential barriers to referral.

A 13-item questionnaire assessing prt knowledge and utilization was sent to 80 Canadian pediatric oncologists.

The survey completion rate was 80%, with most respondents being providers of palliative care for children and making referrals for prt. Although 62% had received training in radiation oncology, only 28% had received formal palliative care training. Respondents with palliative care training were found to be significantly more knowledgeable about prt and were more likely to refer children for prt (p < 0.01). Only 59% of respondents thought that they had adequate knowledge about the indications for prt. A positive correlation was found between knowledge about the indications for prt and referral for treatment (p < 0.01). Among survey respondents, 51% believed that prt was underutilized, and the perceived barriers to prt referral included patient or family reluctance, distance to the cancer centre, belief that prt has little impact on quality of life, and concerns about toxicity.

Palliative radiotherapy is considered to be underutilized among children. This situation appears to be related, in part, to inadequate knowledge and training among pediatric oncologists, suggesting that more emphasis needs to be placed on pediatric palliative care education.

• Pediatric oncology
• barriers
• education
• palliative care
• palliative radiotherapy
• survey
• utilization

To compare the self-reported ratings of functional interference caused by pain between patients who did and did not respond to palliative radiotherapy for bone metastases during their last three months of life.

A prospectively gathered Brief Pain Inventory (BPI) database compiled from patients receiving palliative radiotherapy for painful bone metastases was reviewed. Demographic and clinical data, pain response rates and self-reported ratings of functional interference caused by pain were analyzed for those patients who died within three months of beginning radiotherapy.

From 400 patients in the database, 83 died within 3 months of beginning radiotherapy. There were 54 male and 29 female patients. Their median age was 69 years and their median KPS was 70. The three most common primary cancers were lung (40%), gastrointestinal (16%) and breast (14%). For patients with available follow-up information the 1-month overall pain response rate was 78% and the 2-month rate was 83%, which include both complete and partial responses as defined by the International Bone Metastases Consensus. At 1 month, patients responding to treatment reported significantly less interference by pain on their general activity, walking ability, normal work, sleeping, and enjoyment of life than did patients not responding to treatment.

Patients that responded to treatment reported less functional interference due to pain than did patients who did not respond. Despite being very near the end of life, patients responding to palliative radiotherapy for painful bone metastases may benefit from more than pain relief alone.

• Bone metastases
• Pain
• Palliative care
• Prognosis
• Quality of life
• Radiotherapy

• Aged
• Bone Neoplasms/complications
• Bone Neoplasms/radiotherapy
• Bone Neoplasms/secondary
• Data Interpretation, Statistical
• Factor Analysis, Statistical
• Female
• Humans
• Male
• Middle Aged
• Pain/psychology
• Pain Measurement/instrumentation
• Palliative Care
• Psychometrics
• Reproducibility of Results

• PET 69772 Canadian Institutes of Health Research

Symptom clusters (scs) are a dynamic construct. They consist of at least 2 or 3 interrelated symptoms that may be a significant predictor of patient morbidity. In a previous study, we identified 2 scs in patients with bone metastases:

These scs may be clinically important in the pain and symptom management of patients with metastatic bone pain. It is therefore important to validate the reported scs to determine if they hold true across similar patient populations.

From February to September 2007, our study accrued 52 patients with bone metastases [29 men (56%), 23 women (44%); median age: 68.5 years (range: 39–87 years)] who were referred for palliative radiotherapy (rt). Prostate (31%), breast (29%), and lung (19%) were the most common primary cancer sites. Treatment arms ranged from single to multiple fractions, with most patients receiving a single 8-Gy fraction (77%) or 20 Gy in 5 fractions (21%). The most prevalent sites for rt were spine (42%), hips (17%), and pelvis (14%). Worst pain at the site of rt and functional interference scores were assessed using the Brief Pain Inventory (bpi), a multidimensional pain instrument that uses 11-point numeric rating scales. Patients provided their symptom severity scores on the bpi at baseline and at 4, 8, and 12 weeks post rt. At all time points, a principal component analysis with varimax rotation was performed on 8 items (worst pain and 7 functional interference items) to determine relationships between symptoms before and after rt for bone pain.

Two scs were identified. Cluster 1 included worst pain and interference with general activity, normal work, and walking ability; cluster 2 consisted of interference with mood, sleep, enjoyment of life, and relations with others. Our statistical analysis produced varied results for the 2 clusters found in our previous investigation. These differences may be an indicator for the instability of scs or may be a result of the fewer number of patients accrued in the present validation study.

The scs in our two studies were not identical for patients receiving palliative rt for symptomatic bone metastases. Another sc validation study should be conducted with a larger sample before a conclusion is drawn about the existence of an unstable phenomenon in sc research.

• Bone metastases
• metastatic bone pain
• palliative radio-therapy
• symptom cluster
• symptom cluster instability

• Analgesics/therapeutic use
• Bone Density Conservation Agents/therapeutic use
• Bone Neoplasms/drug therapy
• Bone Neoplasms/physiopathology
• Calcitonin
• Diphosphonates/therapeutic use
• Humans
• Pain/drug therapy
• Pain/etiology
• Radioisotopes
• Radiotherapy