Appendix
← Clinical Reader
Radiation Oncology

Palliative Radiation Therapy For Bone Metastases

Bone metastasis is a common occurrence in many cancers, frequently leading to debilitating symptoms such as pain, pathologic fractures, and compromised quality of life, with the spine being the most frequent site of tumor seeding. With advancements in systemic therapies prolonging the life expectancy of cancer patients, the demand for effective pain relief and functional improvement through palliative radiation therapy for bone metastases has significantly increased. This surge in demand has led

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Malignant spinal cord compression
  • Prevention of pathologic fractures
  • Bone metastasis is a common occurrence in many cancers, frequently leading to debilitating symptoms such as pain, pathologic fractures, and compromised quality of life
  • The 3-DCRT external beam technique first requires a computed tomography (CT) scan of the target lesion and surrounding anatomy.
Mirels scoring system
This scoring system considers the patient's level of cortex involvement, site of bone metastasis, radiographic nature, and pain level to attribute a score.
Spinal instability neoplastic score
This score takes into account the clinical and radiographic findings of the lesion. Points are assigned to the spinal location, with the junctional occiput scoring the highest, pain relief with lying down, bone lesion quality (lytic versus blastic), radiographic spinal alignment, percent of vertebral body collapse, and amount of posterolateral spinal involvement.
  • For patients who do not fall into the surgical treatment category, palliative radiation therapy of the bony metastases is a viable treatment option.
  • The primary goal of palliative radiation therapy is to alleviate pain.
  • The indications for palliative radiotherapy to bone metastasis include: Pain from bone metastases that is difficult to control with oral regimens
  • The American Society for Radiation Oncology (ASTRO) recommends single-fraction EBRT with 8 Gy for palliative pain relief of bone metastases.
  • Contraindications to radiotherapy include patients with a history of inflammatory bowel disease, collagen vascular disease, pregnancy, and those with inherited cancer predisposition syndromes (eg, Down syndrome, Fanconi anemia, Gorlin syndrome, Cockayne syndrome, Gardner syndrome, Usher syndrome, Ataxia-telangiectasia, and Nijmegen breakage syndrome).
  • In addition, patients must be able to tolerate laying still for short periods.
  • Patients must be able to provide informed consent for the procedure.
  • Patients must be able to abide by verbal commands from radiation technicians in the adjacent room.
  • The patient should have reasonable follow-up to monitor the effectiveness of pain control and adverse effects.
  • SBRT is used less often than external beam radiation therapy (EBRT), but SBRT is useful for bone metastasis that is highly radioresistant (eg, sarcoma, renal cell carcinoma, and melanoma) or in the case of oligometastatic disease.
  • Embolization : This technique acts by decreasing the vascularization of bone lesions.
  • Thermal ablation : Radiofrequency, cryoablation, laser, or thermal ablation are various forms of this technique, which uses a variety of agents to induce a rapid temperature change in cells, leading to damage and necrosis.
  • Up to 35% of patients may experience a pain flare within the first week of treatment, which typically resolves in 3 days.
  • Oral dexamethasone 8 mg daily before treatment and for 4 days after can be used to limit pain flare.
  • Other adverse effects due to radiation of the spine include bowel-related symptoms (eg, nausea, diarrhea, or abdominal discomfort).
  • The typical treatment regimen to alleviate nausea symptoms is prescribing 5-HT3 antagonists (ie, seratonin antagonists) before, during, and after treatment.
  • Loperamide and hyoscine butylbromide may be used to treat diarrhea.
  • Adverse effects generally resolve in 4 to 6 weeks after completion of therapy.
  • Up to 40% of patients do not obtain pain relief after initial therapy, and pain relapse is seen in 50% within 1 year of treatment.
  • Patients should be followed after palliative radiotherapy treatments to monitor for adverse effects and to evaluate treatment effectiveness.
  • review
    Palliative Radiation Therapy For Bone Metastases. StatPearls [Internet] — Veronica Garbar, Samuel Richter — StatPearls Publishing, 2024

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov