Bone Mets

Question 1

What are the most common malignant bone lesions?

Answer 1

Metastatic bone tumors are the most common malignant bone lesions.

Question 2

What is the most common form of malignant bone mets tumor?

Answer 2

Prostate cancer is the most common form of malignant bone tumor.

Question 3

What percentage of patients with advanced prostate cancer have bone metastases?

Answer 3

Up to 75% of patients with advanced diagnosis of prostate cancer have bone metastases.

Question 4

Which cancers commonly lead to metastatic bone disease?

Answer 4

Prostate, breast, and lung.

Question 5

Is metastatic bone disease curable?

Answer 5

Metastatic bone disease is not curable; therefore, maintaining a certain quality of life for patients becomes important.

Question 6

What is the treatment for painful metastatic bone tumors?

Answer 6

Palliative radiation therapy is used for painful metastatic bone tumors, typically at a dose of 30 Gy in 2-4 weeks.

Question 7

Where are metastatic bone tumors most commonly located?

Answer 7

The most common location of metastatic bone tumors is in the thoracic spine.

They are also commonly seen in the hips, femur, and ribs.

Question 8

What factors influence the prognosis for metastatic bone disease?

Answer 8

The prognosis depends on the primary site, histology, and degree of metastases at the time of diagnosis.

Question 9

What is the average survival for lung cancer patients with bone metastases?

Answer 9

Lung cancer patients with bone metastases live an average of 6 to 7 months after diagnosis.

Question 10

What is the median survival for breast cancer patients with bony involvement?

Answer 10

Breast cancer patients with bony involvement have a median survival of 19 to 25 months.

Question 11

What is the average survival for prostate cancer patients with metastatic bone disease?

Answer 11

Prostate cancer patients with metastatic bone disease live an average of 12 to 53 months.

Question 12

What are the clinical presentations of bone metastases?

Answer 12

Bone metastases cause pain and skeletal-related events (SREs), including pathologic fractures, spinal cord compression, and forced immobility. All of these are associated with a significant decrease in the quality of life.

Question 13

What is the treatment goal for bone metastases?

Answer 13

The treatment goal of bone metastases is prevention and reduction of the occurrence of skeletal-related events (SREs).

Question 14

What are the goals of treatment for bone Mets?

Answer 14

Palliation of pain and prevention of fractures to weight-bearing bones are very important.

Question 15

What are common characteristics of bone metastases in middle-aged or elderly patients?

Answer 15

Painful osteolytic bone lesions that eat away at bone, swelling, anemia, weakness, pathological fractures, compression fractures of vertebrae, spinal cord compression, infections, and bleeding due to hyperglobulinemia.

Question 16

What is the treatment of choice for bone metastases?

Answer 16

Radiation therapy is the treatment of choice.

Question 17

What therapies can be used for palliation of metastatic bone disease?

Answer 17

EBRT and radiopharmaceutical agents can be used for the palliation of metastatic bone disease.

Question 18

Which radiopharmaceutical agents provide pain relief for metastatic prostate carcinoma?

Answer 18

Strontium-89, Rhenium-186, and Samarium-153 have been shown to provide pain relief for patients with metastatic prostate carcinoma.

Question 19

What is the half-life of Strontium-89?

Answer 19

Strontium-89 has a half-life of 50.5 days.

Question 20

How is radionuclide therapy generally administered?

Answer 20

Radionuclide therapy is generally administered via IV on an outpatient basis with minimal side effects.

Question 21

What is the effectiveness of radiation therapy in treating bone metastases?

Answer 21

Radiation therapy is effective in local control of the lesion, with relief of pain and prevention of the loss of function of the bone.

Question 22

What percentage of patients with bone metastases experience significant pain relief after radiation therapy?

Answer 22

Over 50% of patients with bone metastases have significant pain relief after 5 to 10 fractions.

Question 23

What should spine treatment fields include for bone Mets treatments?

Answer 23

The fields should include the symptomatic vertebrae, with a one-vertebral-body margin above and below.

Question 24

How can healthy bone be shielded during radiation therapy?

Answer 24

MLCs can be used to shield healthy bone and reduce the amount of small bowel in the field.

Question 25

What is the standard dose for palliation in bone metastases?

Answer 25

The standard dose is 30 Gy in 10 fractions.

Question 26

Can optimal pain control be achieved with lower total doses?

Answer 26

Yes, optimal pain control is achievable with lower total doses and higher dose per fraction.

Question 27

What is an example of a lower total dose for pain control?

Answer 27

2000 cGy in 5 fractions.

Clinical trials have shown no significant difference in pain control between the standard dose and other fractionation schemes.

Question 28

What is a common single fraction dose for pain relief?

Answer 28

800 cGy in a single fraction.

This method provides adequate pain relief and saves the patient multiple trips to the clinic.