THE ROLE OF LOCAL RADIOTHERAPY IN THE TRE ATMENT OF BONE METASTASES, PATHOLOGICAL FRACTURES AND CORD COMPRESSION

Local radiotherapy plays an important and responsible role in the mana gement of bone metastases. The valence will be described according to the different treatment objectives in the sense of pain relief, remine ralization and cord decompression. Radiotherapy schedules, aimed at th e relief pain, need to take into consideration life expectancy. patien ts with a reduced life expectancy could have a good high chance of ach ieving pain relief with a single dose of 8 Gy. Patients with a solitar y metastasis, patients with a longer life expectancy and patients with a pathological fracture should be treated with 'curative' irradiation doses, aimed at killing the maximum number of tumor cells. In additio n to pain relief, remineralization is also an important treatment goal . Conventional radiotherapy with doses of 40-50 Gy resulted in pain re lief in 70-100% and in remineralization in 60-80% of the patients. Rem ineralization could not be accelerated by short-course fractionation c ourses, but resulted in faster pain relief. Short-course fractionation schedules are not indicated as a 'standard' treatment in the vertebra l column. Surgery is the treatment of choice for immediate cord decomp ression and stabilization of a pathological vertebral fracture. Radiot herapy alone could decrease neurological impairment and is suitable fo r patients with gradual onset and progression of symptoms, no spinal i nstability and lesions of the cauda equina.