Bone mets video


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Bone mets video

  1. 1. Bone Metastases
  2. 2. Bone Metastases Cancers that originate at another site (usually breast, prostate or lung) that spread to the bone are called bone metastases
  3. 3. Skeleton
  4. 4. 7 cervical Spine 12 thoracic Vertebrae The bones in the spine are5 lumbar numbered 5 sacral
  5. 5. Spinal cord endsat T12-L1
  6. 6. Bone cancer in the spine can createproblems if the tumor compresses the spinalcord inside the neural canal
  7. 7. Pain symptoms are related to the spot in the spine involved
  8. 8. MRI SpinalMetastases fromLung CancerThe mets toL3 caused backPain radiatingInto the legs
  9. 9. MRI of theLumbar Spinewith BoneDestruction of L3from Lymphoma
  10. 10. Bone Metastases Origin: most common sites of origin (primary) are lung, breast, prostate and kidneySymptoms: pain (esp at night), possiblefracture or nerve compression , maycause elevated calcium level or lead toanemia
  11. 11. ribs Most common sites for bonespine metastasespelvis femurs
  12. 12. Some bone metsmake the bone looktoo white(osteoblastic)others make darkholes (lytic)
  13. 13. Lytic = blackhole in theboneBlastic =abnormalwhite area
  14. 14. If not treated, lytic bone mets can causeconsiderable bone destruction
  15. 15. If the cancerhas weakenedthe bone, itmay benecessary toperformsurgery priorto radiation toavoid afracture
  16. 16. Blastic Bone Mets as seen on a CT scan
  17. 17. An MRI may show a bone metbetter than a regular X-ray
  18. 18. Bone Scan A nuclear medicine (technitium) bone scan would show bone mets as dark areas
  19. 19. CT Scans show good bone detail
  20. 20. PET scans may showbone mets very clearly
  21. 21. PET Scans can be used to help target the radiation three dimensionallyPET showing the cancer pushing into the back of the right hipbone
  22. 22. Computer generated reconstruction showing thecancer in red and the radiation zone in orange
  23. 23. A typical course ofradiation is 10treatments ( in somecases it is necessaryto go slower, 20 to25 trips)Bone met at L2Radiation field
  24. 24. 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
  25. 25. 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
  26. 26. Radiation Results•80 - 90% of the time thesymptoms improve•Complete relief in 54%•Most respond by 10-14 days,70% by 2 weeks, 90% by 3months•55 - 70% pain benefit issustained for life
  27. 27. Can You Radiate a Bone Metastasis a second time if the cancer flares up?Effectiveness of Reirradiation for Painful Bone Metastases: A SystematicReview and Meta-Analysis (IJROBP 2012:84:8)Of the 2,694 patients initially treated formetastatic bone pain, 527 (20%) patientsunderwent reirradiation.Overall, a pain response after reirradiationwas achieved in 58% of patients
  28. 28. Xrays may take weeks to months toshow improvement
  29. 29. PET scans can show response to radiationH&N squamous mets to L4 Before XRT 3 months after XRT
  30. 30. Same patient at 7 months, PET scan now totally back to normal
  31. 31. As the cancer shrinks (gray tissue) thebone can regrow
  32. 32. Bone Metastases to the SpineInvolved vertebrae on the left and normal on the right
  33. 33. Kidney cancer inthe spinal vertebraesurrounding thecord, andappearance afterradiation…is itpossible to safelyradiate further?
  34. 34. Radiation prescription for #Diagnosis: #Area Treated: #Number of Treatments:#