Bone metastases occur when cancer spreads from its original site to the bone. Common primary sites are the lung, breast, prostate, and kidney. Symptoms include pain, possible fracture or nerve compression, and elevated calcium levels. Common sites of bone metastases are the spine, ribs, pelvis, and femurs. Bone metastases are typically lytic (creating holes) or blastic (creating abnormal white areas). Radiation therapy is effective in relieving symptoms for most patients and pain response is achieved in 58% of patients undergoing reirradiation for recurrent bone metastases.

1. Bone Metastases

2. Bone Metastases
Cancers that originate
at another site (usually
breast, prostate or
lung) that spread to the
bone are called bone
metastases

3. Skeleton

4. 7 cervical
Spine
12 thoracic
Vertebrae
The bones
in the
spine are
5 lumbar numbered
5 sacral

5. Spinal cord ends
at T12-L1

6. Bone cancer in the spine can create
problems if the tumor compresses the spinal
cord inside the neural canal

7. Pain symptoms are related to the spot in the spine involved

8. MRI Spinal
Metastases from
Lung Cancer
The mets to
L3 caused back
Pain radiating
Into the legs

9. MRI of the
Lumbar Spine
with Bone
Destruction of L3
from Lymphoma

10. Bone Metastases
Origin: most common sites
of origin (primary) are lung,
breast, prostate and kidney
Symptoms: pain (esp at night), possible
fracture or nerve compression , may
cause elevated calcium level or lead to
anemia

11. ribs
Most common
sites for bone
spine
metastases
pelvis
femurs

12. Some bone mets
make the bone look
too white
(osteoblastic)
others make dark
holes (lytic)

13. Lytic = black
hole in the
bone
Blastic =
abnormal
white area

15. If not treated, lytic bone mets can cause
considerable bone destruction

16. If the cancer
has weakened
the bone, it
may be
necessary to
perform
surgery prior
to radiation to
avoid a
fracture

18. Blastic Bone Mets as seen on a CT scan

19. An MRI may show a bone met
better than a regular X-ray

20. Bone Scan
A nuclear medicine
(technitium) bone
scan would show bone
mets as dark areas

22. CT Scans show good bone detail

23. PET scans may show
bone mets very clearly

24. PET Scans can be used to help target
the radiation three dimensionally
PET showing the cancer pushing into the back of the right hip
bone

25. Computer generated reconstruction showing the
cancer in red and the radiation zone in orange

26. A typical course of
radiation is 10
treatments ( in some
cases it is necessary
to go slower, 20 to
25 trips)
Bone met at L2
Radiation field

27. 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

28. 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

29. Radiation Results
•80 - 90% of the time the
symptoms improve
•Complete relief in 54%
•Most respond by 10-14 days,
70% by 2 weeks, 90% by 3
months
•55 - 70% pain benefit is
sustained for life

30. Can You Radiate a Bone Metastasis a
second time if the cancer flares up?
Effectiveness of Reirradiation for Painful Bone Metastases: A Systematic
Review and Meta-Analysis (IJROBP 2012:84:8)
Of the 2,694 patients initially treated for
metastatic bone pain, 527 (20%) patients
underwent reirradiation.
Overall, a pain response after reirradiation
was achieved in 58% of patients

31. Xrays may take weeks to months to
show improvement

32. PET scans can show response to radiation
H&N squamous mets to L4
Before XRT 3 months after XRT

33. Same patient at 7 months, PET scan now
totally back to normal

34. As the cancer shrinks (gray tissue) the
bone can regrow

35. Bone Metastases to the Spine
Involved vertebrae on the left and normal on the right

36. Kidney cancer in
the spinal vertebrae
surrounding the
cord, and
appearance after
radiation…is it
possible to safely
radiate further?

38. Radiation prescription for #
Diagnosis: #
Area Treated: #
Number of Treatments:
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