Follow-up/Toxicity

Question 1

What are the expected acute and late RT toxicities associated with Tx of bone mets?

Answer 1

Potential toxicities from focal RT for bone mets:

Acute: skin irritation, pain flare (30%–40% of pts)

Late: fibrosis, nerve damage, fracture, lymphedema

Question 2

What can be done to reduce pain flare caused by radiating bone mets?

Answer 2

Dexamethasone 8 mg given at least 1 hr prior to the start of RT Tx and then for 4 days following Tx has been shown to reduce pain flare by nearly 10% in a phase III randomized trial. Hyperglycemic events only occurred in 3 pts in the dexamethasone group (2%), and none with adverse consequences. (Chow E et al., Lancet 2015)

Question 3

What is the main toxicity of radionuclide Tx?

Answer 3

Radionuclide Tx can cause significant myelosuppression.

Question 4

Have there been increased toxicities reported from single fx (8 Gy × 1) vs. multi-fx palliative regimens?

Answer 4

No, the ASTRO 2017 guidelines statement summarizes the numerous clinical trials of single-fx vs. multi-fx regimens for palliation of pain, including no increased risk of RT myelopathy for the Tx of spine mets from single-fx regimens.