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<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Palliative Radiation Therapy For Bone Metastases - StatPearls - NCBI Bookshelf</title>
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<meta name="citation_date" content="2024/03/10">
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<meta name="citation_author" content="Veronica Garbar">
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<meta name="citation_author" content="Samuel Richter">
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<meta name="DC.Contributor" content="Veronica Garbar">
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<meta name="DC.Contributor" content="Samuel Richter">
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<meta name="og:description" content="Bone is the site of metastases for many cancers during tumor pathogenesis. The incidence of new cases of bone metastases is estimated to be about 280,000 annually in the United States. Most notably, breast (65% to 75%), prostate cancer (65% to 90%), lung cancer (17% to 64%), and to a lesser extent, bladder cancer (40%), thyroid cancer (65%), melanoma (14% to 45%), kidney cancer (20% to 25%), and colorectal cancer (10%) favor metastases to the bone. Multiple myeloma accounts for about 70% to 95% of bone lesions.[1] ">
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</svg> Books</a></div><div class="jr-rhead f1 flexh"><div class="head"></div><div class="body"><div class="t">Palliative Radiation Therapy For Bone Metastases</div><div class="j">StatPearls [Internet]</div></div><div class="tail"></div></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 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class="title" itemprop="name">Palliative Radiation Therapy For Bone Metastases</span></h1><p class="contribs">Garbar V, Richter S.</p><p class="fm-aai"><a href="#_NBK603757_pubdet_">Publication Details</a></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="article-140969.s1"><h2 id="_article-140969_s1_">Continuing Education Activity</h2><p>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 to the establishment of outpatient and inpatient palliative radiotherapy centers, emphasizing the need for a coordinated, interdisciplinary approach to optimize patient care. With an estimated 280,000 new cases of bone metastases annually in the United States, primarily originating from cancers including breast, prostate, lung, bladder, thyroid, melanoma, kidney, colorectal, and multiple myeloma, effective management strategies are essential to alleviate symptoms and prevent further skeletal injury. Understanding the purpose of palliative therapy, which prioritizes improving quality of life over extending survival, is crucial for clinicians involved in cancer care. This course enhances the learner's understanding of the purpose of palliative therapy, patient selection criteria, treatment modalities, and indications, ensuring the minimization of adverse effects and the enhancement of overall quality of life for cancer patients with extended life expectancy, and underscores the importance of an interprofessional team in delivering high-quality care to patients with bone metastases.</p><p>
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<b>Objectives:</b>
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<ul><li class="half_rhythm"><div>Identify the patient population appropriate for palliative radiation for bone metastases.</div></li><li class="half_rhythm"><div>Differentiate between the various treatment modalities of palliative radiation therapy to the bone.</div></li><li class="half_rhythm"><div>Evaluate the common adverse effects of palliative radiotherapy for bone metastases.</div></li><li class="half_rhythm"><div>Apply interprofessional team strategies to improve care coordination and outcomes in patients treated with palliative radiation for bone metastases.</div></li></ul>
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<a href="https://www.statpearls.com/account/trialuserreg/?articleid=140969&utm_source=pubmed&utm_campaign=reviews&utm_content=140969" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Access free multiple choice questions on this topic.</a>
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</p></div><div id="article-140969.s2"><h2 id="_article-140969_s2_">Introduction</h2><p>Bone is the site of metastases for many cancers during tumor pathogenesis. The incidence of new cases of bone metastases is estimated to be about 280,000 annually in the United States. Most notably, breast (65% to 75%), prostate cancer (65% to 90%), lung cancer (17% to 64%), and to a lesser extent, bladder cancer (40%), thyroid cancer (65%), melanoma (14% to 45%), kidney cancer (20% to 25%), and colorectal cancer (10%) favor metastases to the bone. Multiple myeloma accounts for about 70% to 95% of bone lesions.<a class="bibr" href="#article-140969.r1" rid="article-140969.r1">[1]</a> </p><p>The structural bone damage that ensues leads to significant pain, pathologic fractures, and decreased quality of life.<a class="bibr" href="#article-140969.r2" rid="article-140969.r2">[2]</a> Metastasis can occur in 3 main anatomic locations: the extremities, pelvis, and spine. The most common site of metastatic bone lesions is the spine. The most common location is the thoracic spine (60% to 70%) of the spinal columns. The lumbosacral spine accounts for 20% to 25%, followed by the cervical spine with 10% to 15% of spinal metastasis.<a class="bibr" href="#article-140969.r3" rid="article-140969.r3">[3]</a><a class="bibr" href="#article-140969.r4" rid="article-140969.r4">[4]</a><a class="bibr" href="#article-140969.r5" rid="article-140969.r5">[5]</a><a class="bibr" href="#article-140969.r6" rid="article-140969.r6">[6]</a><a class="bibr" href="#article-140969.r7" rid="article-140969.r7">[7]</a> The upper extremity accounts for about 24%, whereas the lower extremity accounts for about 76% of the long bone metastases.<a class="bibr" href="#article-140969.r8" rid="article-140969.r8">[8]</a></p><p>The primary reason for treating bone metastases is to prevent further skeletal injury and improve symptoms. Generally, surgical treatment options are offered to patients with a life expectancy greater than 6 weeks. Those with a life expectancy of 3 to 12 months are treated with minimally invasive surgery. En bloc resection of metastatic lesions may be the best option for patients with a life expectancy of 12 months or more.<a class="bibr" href="#article-140969.r9" rid="article-140969.r9">[9]</a><a class="bibr" href="#article-140969.r10" rid="article-140969.r10">[10]</a> For patients who do not fall into the surgical treatment category, palliative radiation therapy of the bony metastases is a viable treatment option.</p></div><div id="article-140969.s3"><h2 id="_article-140969_s3_">Anatomy and Physiology</h2><p>Healthy bone is in a constant state of turnover. Bone is deposited by osteoblasts, with absorption occurring via osteoclasts. Osteoclasts function under the influence of parathyroid hormone and calcitonin in response to calcium levels. Osteoclasts secrete enzymes and acids to mediate bone deposition and formation. Bone metastasis occurs due to growth at the primary tumor site, leading to tumor neovascularization. Tumor cells then detach from the primary tumor bed and invade nearby tissues with invasion into the blood. The tumor cells that survive in circulation then enter the bone marrow. In the bone marrow, the cells evade host defenses and further growth with stimulation of osteoclasts, leading to further bone resorption.<a class="bibr" href="#article-140969.r11" rid="article-140969.r11">[11]</a> Cancer cells can release a whole host of growth factors that propagate osteoclasts. In addition, bone metastasis produces an increased inflammatory cell response, resulting in pain. The other mechanisms of bone pain relate to infiltration of the nerve root, microfractures, stretching of the periosteum, increased pressure in the bone, muscle spasms, and nerve compression.<a class="bibr" href="#article-140969.r12" rid="article-140969.r12">[12]</a></p></div><div id="article-140969.s4"><h2 id="_article-140969_s4_">Indications</h2><p>The primary goal of palliative radiation therapy is to alleviate pain. After treatment, most patients will expect to experience pain relief in 2 to 3 weeks in 60% of patients.<a class="bibr" href="#article-140969.r13" rid="article-140969.r13">[13]</a><a class="bibr" href="#article-140969.r14" rid="article-140969.r14">[14]</a> The indications for palliative radiotherapy to bone metastasis include:</p><ul><li class="half_rhythm"><div>Pain from bone metastases that is difficult to control with oral regimens</div></li><li class="half_rhythm"><div>Malignant spinal cord compression</div></li><li class="half_rhythm"><div>Prevention of pathologic fractures</div></li></ul></div><div id="article-140969.s5"><h2 id="_article-140969_s5_">Contraindications</h2><p>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).<a class="bibr" href="#article-140969.r15" rid="article-140969.r15">[15]</a> 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.<a class="bibr" href="#article-140969.r16" rid="article-140969.r16">[16]</a></p></div><div id="article-140969.s6"><h2 id="_article-140969_s6_">Personnel</h2><p>To design radiotherapy treatment, the radiation oncology team includes:</p><ul><li class="half_rhythm"><div><b>Radiation oncologists</b>: Board-certified clinicians in radiology oncology evaluate patients with various cancers for radiation therapy.</div></li><li class="half_rhythm"><div><b>Dosimetrists</b>: Licensed health professionals who design the most potent radiation dosing possible for the area of interest with the fewest adverse effects of radiation.</div></li><li class="half_rhythm"><div><b>Medical physicists</b>: Certified in therapeutic medical physics, these individuals work with dosimetrists to create effective treatment plans based on tumor location to deliver potent radiation with minimal healthy tissue involvement. Physicists ensure that the treatment plan is the actual plan delivered with the machine through a series of quality assurance checks before the patient is treated.</div></li><li class="half_rhythm"><div><b>Radiation therapists</b>: These licensed therapists operate the machinery required to deliver treatment.</div></li><li class="half_rhythm"><div><b>Radiation oncology nurses and support staff</b>: Specialized team members responsible for aiding in simulation setup, scheduling, and patient management.</div></li></ul></div><div id="article-140969.s7"><h2 id="_article-140969_s7_">Technique or Treatment</h2><p>
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<b>Radiotherapy Administration</b>
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</p><p>A dedicated center uses a linear accelerator to deliver high-energy x-rays to the target lesion. Before receiving treatment, patients are examined in a consultation session termed simulation. During simulation, the patient is placed in an optimal position to treat the target lesion. The position must balance patient comfort, tolerance, and reproducibility at future appointments. The patient is expected to be in nearly the same position for all treatment appointments. Typically, patients must be able to lie still for roughly 15 to 30 minutes to complete a single treatment. A patient may need to wear a tight-fitting mask or garment when treating upper neck, head, and chest lesions. These high-energy beams delivered during treatment cause DNA damage and lead to cell death. Most patients undergoing curative treatment are scheduled to receive small daily doses called fractions. The fragmentation of radiotherapy treatment into smaller fractions reduces harm to healthy tissue near the target lesion and aids in avoiding permanent adverse effects. Patients undergoing palliative treatments typically receive a lower total dose, shifting the focus to symptom management of pain. The result for a patient receiving palliative radiotherapy is a shorter duration of a larger fraction.<a class="bibr" href="#article-140969.r16" rid="article-140969.r16">[16]</a></p><p>
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<b>Radiotherapy Techniques</b>
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</p><p>The primary radiotherapy techniques utilized are 3-dimensional conformal radiation therapy (3-DCRT) and stereotactic body radiation (SBRT). The 3-DCRT external beam technique first requires a computed tomography (CT) scan of the target lesion and surrounding anatomy. In the case of spine metastasis to a vertebral body, the desired dose to the target volume is delivered to the site of the bone metastasis, including the vertebral body, often including a vertebral level above and below the lesion. Using 3-DCRT spares neighboring critical organs at risk.<a class="bibr" href="#article-140969.r17" rid="article-140969.r17">[17]</a> However, SBRT delivers high doses of radiation to the target lesion with greater accuracy. This treatment modality allows minimal dose to surrounding structures in the treatment field and involves only the tumor.<a class="bibr" href="#article-140969.r18" rid="article-140969.r18">[18]</a><a class="bibr" href="#article-140969.r19" rid="article-140969.r19">[19]</a> 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.</p><p>As of July 2023, a new study evaluated SBRT with EBRT for patients with painful spine metastases. The trial included 339 randomized patients with 1 to 3 spinal metastases where a pain response was measured on an 11-point scale. The results showed that EBRT elicited a complete or partial pain response more commonly than SBRT (61% versus 41%). EBRT continues to be used for most patients with a finite number of spinal bone metastases.<a class="bibr" href="#article-140969.r20" rid="article-140969.r20">[20]</a></p><p>
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<b>Recommended Treatment Course</b>
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</p><p>The American Society for Radiation Oncology (ASTRO) recommends single-fraction EBRT with 8 Gy for palliative pain relief of bone metastases. Fractionation schedules lead to higher costs and patient inconvenience than a single-fraction treatment plan.<a class="bibr" href="#article-140969.r21" rid="article-140969.r21">[21]</a> An updated review of high-quality data shows pain relief equivalency following a single 8 Gy fraction, 20 Gy in 5 fractions, 24 Gy in 6 fractions, and 30 Gy in 10 fractions for patients with previously unirradiated painful bone metastases. Patients should be aware that single-fraction radiotherapy is associated with a higher incidence of retreatment to the same painful site compared to fractionated treatment.<a class="bibr" href="#article-140969.r22" rid="article-140969.r22">[22]</a></p><p>At times, surgery may be required before beginning radiation in patients who experience pathologic fracture of the long bones. Surgery may also be performed prophylactically to prevent pathologic fracture occurrence. Should a patient undergo surgical stabilization, radiotherapy is often administered postoperatively to provide local control of disease and alleviate associated pain. Several scoring systems have been developed to provide a more objective way of predicting patients' fracture risk with metastatic disease to long bones and vertebral lesions, including:</p><ul><li class="half_rhythm"><div><b>Mirels scoring system:</b> This scoring system considers the patient's level of cortex involvement, site of bone metastasis, radiographic nature, and pain level to attribute a score. The system is used to evaluate long bones with metastatic disease. Scoring <7 leads to a <10% fracture risk. A score of 8 has a 15% chance of fracture, and fixation should be considered. Scores ≥9 have more than a 33% chance of fracture and should be seen by an orthopedist. Generally, scores ≥8 should have an orthopedic consultation to assess prophylactic fixation.<a class="bibr" href="#article-140969.r23" rid="article-140969.r23">[23]</a></div></li></ul><ul><li class="half_rhythm"><div><b>Spinal instability neoplastic score:</b> A scoring system developed to assess vertebral metastases. 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. When all 6 components are combined, a score of 13 to 18 designates instability and should prompt a surgical consultation; scores between 7 and 12 are indeterminate and should involve a surgical consultation. Scores of ≤6 are considered a stable spine.<a class="bibr" href="#article-140969.r24" rid="article-140969.r24">[24]</a></div></li></ul><p>
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<b>Interventional Radiology Techniques</b>
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</p><p>The following interventional radiology techniques may also be utilized in patients with bone metastases:</p><ul><li class="half_rhythm"><div><b>Embolization</b>: This technique acts by decreasing the vascularization of bone lesions. Embolic agents (nano-particles) are injected after peripheral artery access to the desired arterial location.<a class="bibr" href="#article-140969.r25" rid="article-140969.r25">[25]</a></div></li><li class="half_rhythm"><div><b>Thermal ablation</b>: 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.<a class="bibr" href="#article-140969.r26" rid="article-140969.r26">[26]</a></div></li><li class="half_rhythm"><div><b>Radiofrequency ablation</b>: Computed tomography guidance is utilized to place ablation probes in the center of the tumor.<a class="bibr" href="#article-140969.r27" rid="article-140969.r27">[27]</a> The downside to this technique is potential pain, and patients typically need sedation or analgesia.</div></li><li class="half_rhythm"><div><b>Microwave ablation</b>: This technique typically provides faster coagulation and is less time-consuming than other techniques. Like radiofrequency ablation, an ablation probe is placed in the center of the tumor, and a set energy and time is used to complete the ablation.<a class="bibr" href="#article-140969.r28" rid="article-140969.r28">[28]</a></div></li><li class="half_rhythm"><div><b>Nonpercutaneous thermal ablation-high-intensity focused ultrasound ablation</b>: This technique uses focused ultrasound beams backed by energy to burn the lesion that can be combined with magnetic resonance imaging-guided intensity-focused ultrasound as a noninvasive way of ablation to achieve coagulative necrosis.<a class="bibr" href="#article-140969.r29" rid="article-140969.r29">[29]</a></div></li><li class="half_rhythm"><div><b>Cementoplasty:</b> Polymethyl methacrylate is injected into the bone portion weakened by metastasis. The compound acts to strengthen the bone to reduce pain.<a class="bibr" href="#article-140969.r30" rid="article-140969.r30">[30]</a><a class="bibr" href="#article-140969.r31" rid="article-140969.r31">[31]</a></div></li></ul></div><div id="article-140969.s8"><h2 id="_article-140969_s8_">Complications</h2><p>Most adverse effects relate to the anatomic location treated and fraction used. The most common adverse effect after treatment is fatigue. Up to 35% of patients may experience a pain flare within the first week of treatment, which typically resolves in 3 days.<a class="bibr" href="#article-140969.r32" rid="article-140969.r32">[32]</a> Oral dexamethasone 8 mg daily before treatment and for 4 days after can be used to limit pain flare.<a class="bibr" href="#article-140969.r33" rid="article-140969.r33">[33]</a> 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. Long-term complications are not common.<a class="bibr" href="#article-140969.r16" rid="article-140969.r16">[16]</a></p><p>At times, repeated irradiation to the target lesion is required when the patient does not experience a response, pain recurs, or only a partial response is achieved. 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.<a class="bibr" href="#article-140969.r34" rid="article-140969.r34">[34]</a> No defined recommendation exists for reirradiation. A radiation oncologist should follow patients who have undergone repeated irradiation at their discretion.</p></div><div id="article-140969.s9"><h2 id="_article-140969_s9_">Clinical Significance</h2><p>The use of palliative radiotherapy has increased as the population with cancer has been able to reach a higher life expectancy. A well-organized, interprofessional team approach is required to utilize radiotherapy effectively. Understanding the appropriate indication and patient selection for treatment is critical in limiting complications and damage to surrounding structures and improving overall patient quality of life. Clinicians taking care of cancer patients should fully comprehend the utility of palliative radiotherapy when discussing care plans with patients who are no longer systemic therapy or surgical candidates. Educating patients on the role of palliative therapy is of high importance. Patients must understand the intent of treatment is to improve quality of life, not necessarily improve survival. Though adverse effects occur in any treatment in medicine, palliative radiotherapy is often well-tolerated and individualized such that most patients can complete their proposed treatment plans.</p></div><div id="article-140969.s10"><h2 id="_article-140969_s10_">Enhancing Healthcare Team Outcomes </h2><p>An interprofessional approach involving various healthcare professionals is vital for optimizing patient-centered care and outcomes related to palliative radiation therapy for bone metastases, consisting of medical oncologists, radiation oncologists, surgeons, pain management specialists, interventional radiologists, and palliative care clinicians. Effective communication and collaboration among these professionals are crucial for timely referral and patient selection, especially considering clinicians' challenges in identifying suitable candidates and involving radiation oncologists promptly. This collaborative effort aims to bridge the practice gap by effectively addressing variable referral patterns, disseminating guidelines, and rectifying misconceptions about treatment efficacy and adverse effects. By understanding the patient's primary cancer diagnosis, medical comorbidities, and life expectancy, healthcare professionals can tailor treatment plans to prevent further skeletal injury, alleviate symptoms, and enhance overall patient quality of life. Additionally, patient education regarding the role of palliative therapy is essential to align expectations and improve treatment adherence. Through interprofessional collaboration, healthcare professionals can optimize patient-centered care, improve outcomes, ensure patient safety, and effectively enhance team performance in managing bone metastases.</p></div><div id="article-140969.s11"><h2 id="_article-140969_s11_">Nursing, Allied Health, and Interprofessional Team Monitoring</h2><p>Patients should be followed after palliative radiotherapy treatments to monitor for adverse effects and to evaluate treatment effectiveness. Generally, patients should be seen by their medical oncologist, radiation oncologist, and other interprofessional team members to ensure patient safety and satisfaction.</p></div><div id="article-140969.s12"><h2 id="_article-140969_s12_">Review Questions</h2><ul><li class="half_rhythm"><div>
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</div></li></ul></div><div id="article-140969.s13"><h2 id="_article-140969_s13_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="article-140969.r1">Sousa S, Clézardin P. Bone-Targeted Therapies in Cancer-Induced Bone Disease. <span><span class="ref-journal">Calcif Tissue Int. </span>2018 Feb;<span class="ref-vol">102</span>(2):227-250.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29079995" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29079995</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="article-140969.r2">Coleman RE, Croucher PI, Padhani AR, Clézardin P, Chow E, Fallon M, Guise T, Colangeli S, Capanna R, Costa L. Bone metastases. <span><span class="ref-journal">Nat Rev Dis Primers. </span>2020 Oct 15;<span class="ref-vol">6</span>(1):83.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33060614" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33060614</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="article-140969.r3">Tsukamoto S, Kido A, Tanaka Y, Facchini G, Peta G, Rossi G, Mavrogenis AF. Current Overview of Treatment for Metastatic Bone Disease. <span><span class="ref-journal">Curr Oncol. </span>2021 Aug 29;<span class="ref-vol">28</span>(5):3347-3372.</span> [<a href="/pmc/articles/PMC8482272/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8482272</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34590591" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34590591</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="article-140969.r4">Igoumenou VG, Mavrogenis AF, Angelini A, Baracco R, Benzakour A, Benzakour T, Bork M, Vazifehdan F, Nena U, Ruggieri P. Complications of spine surgery for metastasis. <span><span class="ref-journal">Eur J Orthop Surg Traumatol. </span>2020 Jan;<span class="ref-vol">30</span>(1):37-56.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/31473821" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31473821</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="article-140969.r5">Quraishi NA, Gokaslan ZL, Boriani S. The surgical management of metastatic epidural compression of the spinal cord. <span><span class="ref-journal">J Bone Joint Surg Br. </span>2010 Aug;<span class="ref-vol">92</span>(8):1054-60.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20675746" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20675746</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="article-140969.r6">Vazifehdan F, Karantzoulis VG, Igoumenou VG. Surgical treatment for metastases of the cervical spine. <span><span class="ref-journal">Eur J Orthop Surg Traumatol. </span>2017 Aug;<span class="ref-vol">27</span>(6):763-775.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28638950" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28638950</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="article-140969.r7">Mavrogenis AF, Pneumaticos S, Sapkas GS, Papagelopoulos PJ. Metastatic epidural spinal cord compression. <span><span class="ref-journal">Orthopedics. </span>2009 Jun;<span class="ref-vol">32</span>(6):431-9; quiz 440-1.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19634817" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19634817</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="article-140969.r8">Ratasvuori M, Wedin R, Keller J, Nottrott M, Zaikova O, Bergh P, Kalen A, Nilsson J, Jonsson H, Laitinen M. Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis. <span><span class="ref-journal">Surg Oncol. </span>2013 Jun;<span class="ref-vol">22</span>(2):132-8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23562148" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23562148</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="article-140969.r9">Errani C, Cosentino M, Ciani G, Ferra L, Alfaro PA, Bordini B, Donati DM. C-reactive protein and tumour diagnosis predict survival in patients treated surgically for long bone metastases. <span><span class="ref-journal">Int Orthop. </span>2021 May;<span class="ref-vol">45</span>(5):1337-1346.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33392682" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33392682</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="article-140969.r10">Errani C, Mavrogenis AF, Cevolani L, Spinelli S, Piccioli A, Maccauro G, Baldini N, Donati D. Treatment for long bone metastases based on a systematic literature review. <span><span class="ref-journal">Eur J Orthop Surg Traumatol. </span>2017 Feb;<span class="ref-vol">27</span>(2):205-211.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27650452" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27650452</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="article-140969.r11">Choong PF. The molecular basis of skeletal metastases. <span><span class="ref-journal">Clin Orthop Relat Res. </span>2003 Oct;(415 Suppl):S19-31.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/14600589" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14600589</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="article-140969.r12">Vakaet LA, Boterberg T. Pain control by ionizing radiation of bone metastasis. <span><span class="ref-journal">Int J Dev Biol. </span>2004;<span class="ref-vol">48</span>(5-6):599-606.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15349834" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15349834</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="article-140969.r13">Chow E, Zeng L, Salvo N, Dennis K, Tsao M, Lutz S. Update on the systematic review of palliative radiotherapy trials for bone metastases. <span><span class="ref-journal">Clin Oncol (R Coll Radiol). </span>2012 Mar;<span class="ref-vol">24</span>(2):112-24.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22130630" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22130630</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="article-140969.r14">Sze WM, Shelley M, Held I, Mason M. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy - a systematic review of the randomised trials. <span><span class="ref-journal">Cochrane Database Syst Rev. </span>2004;<span class="ref-vol">2002</span>(2):CD004721.</span> [<a href="/pmc/articles/PMC6599833/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6599833</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/15106258" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15106258</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="article-140969.r15">Lin D, Lehrer EJ, Rosenberg J, Trifiletti DM, Zaorsky NG. Toxicity after radiotherapy in patients with historically accepted contraindications to treatment (CONTRAD): An international systematic review and meta-analysis. <span><span class="ref-journal">Radiother Oncol. </span>2019 Jun;<span class="ref-vol">135</span>:147-152.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/31015161" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31015161</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="article-140969.r16">Spencer K, Parrish R, Barton R, Henry A. Palliative radiotherapy. <span><span class="ref-journal">BMJ. </span>2018 Mar 23;<span class="ref-vol">360</span>:k821.</span> [<a href="/pmc/articles/PMC5865075/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5865075</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29572337" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29572337</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="article-140969.r17">De Felice F, Piccioli A, Musio D, Tombolini V. The role of radiation therapy in bone metastases management. <span><span class="ref-journal">Oncotarget. </span>2017 Apr 11;<span class="ref-vol">8</span>(15):25691-25699.</span> [<a href="/pmc/articles/PMC5421962/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5421962</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28148890" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28148890</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="article-140969.r18">Maranzano E, Trippa F, Casale M, Costantini S, Lupattelli M, Bellavita R, Marafioti L, Pergolizzi S, Santacaterina A, Mignogna M, Silvano G, Fusco V. 8Gy single-dose radiotherapy is effective in metastatic spinal cord compression: results of a phase III randomized multicentre Italian trial. <span><span class="ref-journal">Radiother Oncol. </span>2009 Nov;<span class="ref-vol">93</span>(2):174-9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19520448" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19520448</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="article-140969.r19">Palma DA, Salama JK, Lo SS, Senan S, Treasure T, Govindan R, Weichselbaum R. The oligometastatic state - separating truth from wishful thinking. <span><span class="ref-journal">Nat Rev Clin Oncol. </span>2014 Sep;<span class="ref-vol">11</span>(9):549-57.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24958182" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24958182</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="article-140969.r20">Ryu S, Deshmukh S, Timmerman RD, Movsas B, Gerszten P, Yin FF, Dicker A, Abraham CD, Zhong J, Shiao SL, Tuli R, Desai A, Mell LK, Iyengar P, Hitchcock YJ, Allen AM, Burton S, Brown D, Sharp HJ, Dunlap NE, Siddiqui MS, Chen TH, Pugh SL, Kachnic LA. Stereotactic Radiosurgery vs Conventional Radiotherapy for Localized Vertebral Metastases of the Spine: Phase 3 Results of NRG Oncology/RTOG 0631 Randomized Clinical Trial. <span><span class="ref-journal">JAMA Oncol. </span>2023 Jun 01;<span class="ref-vol">9</span>(6):800-807.</span> [<a href="/pmc/articles/PMC10119775/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10119775</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37079324" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37079324</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="article-140969.r21">Lutz S, Balboni T, Jones J, Lo S, Petit J, Rich SE, Wong R, Hahn C. Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline. <span><span class="ref-journal">Pract Radiat Oncol. </span>2017 Jan-Feb;<span class="ref-vol">7</span>(1):4-12.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27663933" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27663933</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="article-140969.r22">Lutz S, Berk L, Chang E, Chow E, Hahn C, Hoskin P, Howell D, Konski A, Kachnic L, Lo S, Sahgal A, Silverman L, von Gunten C, Mendel E, Vassil A, Bruner DW, Hartsell W., American Society for Radiation Oncology (ASTRO). Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. <span><span class="ref-journal">Int J Radiat Oncol Biol Phys. </span>2011 Mar 15;<span class="ref-vol">79</span>(4):965-76.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21277118" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21277118</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="article-140969.r23">Johnson SK, Knobf MT. Surgical interventions for cancer patients with impending or actual pathologic fractures. <span><span class="ref-journal">Orthop Nurs. </span>2008 May-Jun;<span class="ref-vol">27</span>(3):160-71; quiz 172-3.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/18521030" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18521030</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="article-140969.r24">Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, Harrop JS, Fehlings MG, Boriani S, Chou D, Schmidt MH, Polly DW, Biagini R, Burch S, Dekutoski MB, Ganju A, Gerszten PC, Gokaslan ZL, Groff MW, Liebsch NJ, Mendel E, Okuno SH, Patel S, Rhines LD, Rose PS, Sciubba DM, Sundaresan N, Tomita K, Varga PP, Vialle LR, Vrionis FD, Yamada Y, Fourney DR. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. <span><span class="ref-journal">Spine (Phila Pa 1976). </span>2010 Oct 15;<span class="ref-vol">35</span>(22):E1221-9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20562730" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20562730</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="article-140969.r25">Sgalambro F, Zugaro L, Bruno F, Palumbo P, Salducca N, Zoccali C, Barile A, Masciocchi C, Arrigoni F. Interventional Radiology in the Management of Metastases and Bone Tumors. <span><span class="ref-journal">J Clin Med. </span>2022 Jun 07;<span class="ref-vol">11</span>(12)</span> [<a href="/pmc/articles/PMC9225477/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9225477</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35743336" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35743336</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="article-140969.r26">Dalili D, Isaac A, Bazzocchi A, Åström G, Bergh J, Lalam R, Weber MA, Fritz J, Mansour R. Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation. <span><span class="ref-journal">Semin Musculoskelet Radiol. </span>2020 Dec;<span class="ref-vol">24</span>(6):692-709.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33307585" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33307585</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="article-140969.r27">Rybak LD. Fire and ice: thermal ablation of musculoskeletal tumors. <span><span class="ref-journal">Radiol Clin North Am. </span>2009 May;<span class="ref-vol">47</span>(3):455-69.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19361670" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19361670</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="article-140969.r28">Brace CL, Laeseke PF, Sampson LA, Frey TM, van der Weide DW, Lee FT. Microwave ablation with multiple simultaneously powered small-gauge triaxial antennas: results from an in vivo swine liver model. <span><span class="ref-journal">Radiology. </span>2007 Jul;<span class="ref-vol">244</span>(1):151-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17581900" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17581900</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="article-140969.r29">Bazzocchi A, Napoli A, Sacconi B, Battista G, Guglielmi G, Catalano C, Albisinni U. MRI-guided focused ultrasound surgery in musculoskeletal diseases: the hot topics. <span><span class="ref-journal">Br J Radiol. </span>2016;<span class="ref-vol">89</span>(1057):20150358.</span> [<a href="/pmc/articles/PMC4985948/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4985948</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26607640" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26607640</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="article-140969.r30">Health Quality Ontario. Vertebral Augmentation Involving Vertebroplasty or Kyphoplasty for Cancer-Related Vertebral Compression Fractures: An Economic Analysis. <span><span class="ref-journal">Ont Health Technol Assess Ser. </span>2016;<span class="ref-vol">16</span>(12):1-34.</span> [<a href="/pmc/articles/PMC4901201/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4901201</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27293494" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27293494</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="article-140969.r31">Masala S, Chiocchi M, Taglieri A, Bindi A, Nezzo M, De Vivo D, Simonetti G. Combined use of percutaneous cryoablation and vertebroplasty with 3D rotational angiograph in treatment of single vertebral metastasis: comparison with vertebroplasty. <span><span class="ref-journal">Neuroradiology. </span>2013 Feb;<span class="ref-vol">55</span>(2):193-200.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23014893" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23014893</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="article-140969.r32">Zwaan J. Immunofluorescent studies on aphakia, a mutation of a gene involved in the control of lens differentiation in the mouse embryo. <span><span class="ref-journal">Dev Biol. </span>1975 Jun;<span class="ref-vol">44</span>(2):306-12.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1093912" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1093912</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="article-140969.r33">Chow E, Meyer RM, Ding K, Nabid A, Chabot P, Wong P, Ahmed S, Kuk J, Dar AR, Mahmud A, Fairchild A, Wilson CF, Wu JSY, Dennis K, Brundage M, DeAngelis C, Wong RKS. Dexamethasone in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a double-blind, randomised placebo-controlled, phase 3 trial. <span><span class="ref-journal">Lancet Oncol. </span>2015 Nov;<span class="ref-vol">16</span>(15):1463-1472.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26489389" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26489389</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="article-140969.r34">Huisman M, van den Bosch MA, Wijlemans JW, van Vulpen M, van der Linden YM, Verkooijen HM. Effectiveness of reirradiation for painful bone metastases: a systematic review and meta-analysis. <span><span class="ref-journal">Int J Radiat Oncol Biol Phys. </span>2012 Sep 01;<span class="ref-vol">84</span>(1):8-14.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22300568" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22300568</span></a>]</div></dd></dl></dl></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Veronica Garbar declares no relevant financial relationships with ineligible companies.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Samuel Richter declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></dl></div></div></div><div class="fm-sec"><h2 id="_NBK603757_pubdet_">Publication Details</h2><h3>Author Information and Affiliations</h3><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Veronica Garbar</span><sup>1</sup>; <span itemprop="author">Samuel Richter</span><sup>2</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> Florida Atlantic University General Surgery Residency</div><div class="affiliation"><sup>2</sup> Lynn Cancer Institute - Baptist Health South Florida</div><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">March 10, 2024</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2025, StatPearls Publishing LLC.<p class="small">
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This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
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(<a href="https://creativecommons.org/licenses/by-nc-nd/4.0/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=uri">
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http://creativecommons.org/licenses/by-nc-nd/4.0/
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</a>), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
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</p></div></div><h3>Publisher</h3><p><a href="https://www.statpearls.com/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">StatPearls Publishing</a>, Treasure Island (FL)</p><h3>NLM Citation</h3><p>Garbar V, Richter S. Palliative Radiation Therapy For Bone Metastases. [Updated 2024 Mar 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. <span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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