SKELETAL METASTASES

This synthesis of the literature on radiotherapy for skeletal metastas es is based on 171 scientific articles, including 13 randomized studie s, 24 prospective studies, and 79 retrospective studies. These studies involve 13054 patients.Radiotherapy has been well documented as a met hod for alleviating pain, but the mechanisms underlying this effect ar e largely unknown. When used for pain palliation, radiotherapy achieve s freedom from pain, or substantial alleviation of pain in nearly all cases, with few side effects. Half-body irradiation is effective in tr eating multiple metastatic sites and should be considered for use more frequently. However, this increases the requirements on equipment, do simetry, and hospital beds. Systemic radiotherapy with radionuclides m ay be indicated for generalized skeletal pain. The role of radiotherap y in preventing or healing fractures is not fully evaluated. Optimum d ose levels and fractionation schedules have not been established. Earl y radiotherapy for spinal cord compression may prevent symptoms from w orsening, but the effects on existing paralysis are modest.