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American Cancer Society - Reference Material
Treating Bone Metastasis
Detailed Guide: Bone Metastasis
How Is Bone Metastasis Treated?

Treatment options for people with bone metastases depend on where
the primary cancer developed, which bones it has spread to, and
whether any bones are severely weakened or broken. Other factors
will also be considered, such as specific features of the cancer
cells (in the case of breast cancer, whether they contain estrogen
receptors), your general state of health, and which treatments you
have already received.

Most doctors feel the most important treatment for bone metastases
is treatment directed against the cancer. This is usually done with
systemic therapies, such as chemotherapy or hormonal therapy,that
are taken by mouth or injected. Also, bisphosphonate therapy can
help to make diseased bones stronger and help prevent fractures. It
is used to supplement the chemotherapy or hormonal therapy for bone
metastasis. Systemic therapies enter the bloodstream, and can
therefore reach cancer cells that have spread throughout the body.
If this is successful, then the symptoms of the bone metastases will
go away and new symptoms are not likely to develop soon.

It also may be important to treat the bone problems. Local
treatments such as radiation therapy can relieve the pain in a bone
area by destroying the cancer. Sometimes a bone such as your femur
(thigh bone) might look as if it is close to breaking. Your doctor
will recommend that you have a surgical procedure to prevent this.
In this procedure, a doctor, usually an orthopedic surgeon places a
thin steel rod in the bone. It is much easier to prevent a damaged
femur from breaking than to repair it after it has broken.

This section begins with a summary of the types of systemic
treatments used for patients with metastatic cancers. For more
detailed information about treatment of metastatic cancer based on a
specific type of cancer, please refer to our information on each
cancer type. The information on metastatic cancer will be included
in the sections on treatment of advanced cancer, stage IV cancer, or
recurrent cancer. The second part of this section contains
information that focuses specifically on treatment of bone
metastases.

Systemic Therapy

Chemotherapy: Chemotherapy uses anticancer drugs that are usually
injected into a vein or taken by mouth. These drugs enter the
bloodstream and can reach cancer that has spread. Chemotherapy is
used as the main treatment to cure some metastatic cancers such as
lymphomas and germ cell tumors of the ovaries, testicles, or
placenta. Combining chemotherapy with other treatments can often
cure some children's cancers such as Wilms tumor and osteosarcoma.

Chemotherapy drugs kill cancer cells but also damage some normal
cells. Therefore, careful attention must be given to avoiding or
minimizing side effects, which depend on the type of drugs, the
amount taken, and the length of treatment. Temporary side effects
might include nausea and vomiting, loss of appetite, loss of hair,
and mouth sores. Because chemotherapy can damage the blood-producing
cells of your bone marrow, you may have low blood cell counts. Low
blood cell counts can result in:

   * An increased chance of infection (caused by a shortage of
white blood cells)
   * Bleeding or bruising after minor cuts or injuries (caused by a
shortage of blood platelets)
   * Fatigue (caused by low red blood cell counts).

Most side effects disappear once treatment is stopped. There are
remedies to prevent or control many of the temporary side effects of
chemotherapy. For example, drugs can be given to prevent or reduce
nausea and vomiting (these are called antiemetic drugs). For more
information on chemotherapy, please see "Understanding Chemotherapy:
a Guide for Patients and Families."

Hormone therapy: Estrogen, a hormone produced by women's ovaries,
promotes growth of some breast cancers, particularly those cancers
with detectable amounts of estrogen receptor protein. Likewise,
androgens such as testosterone, which are produced by the testicles,
promote growth of most prostate cancers. There are several types of
hormone therapy:

   * One strategy is to remove the organs that produce hormones.
Removing the ovaries or testicles is a hormone therapy option for
patients with breast cancer or prostate cancer, respectively.
   * More often, drugs can be given to keep hormones from being
produced (a common approach to hormone therapy for prostate cancer).

   * Other drugs can be given to prevent the hormones from
affecting the cancer cells For example, drugs such as tamoxifen
block hormone effects on breast cancers and anti-androgens block
hormone effects on prostate cancer.
   * Side effects depend on the type of hormone treatments used,
but may include hot flashes, blood clots, loss of libido (sex
drive), and increased risk of other cancers

Immunotherapy: Immunotherapy is a systemic therapy that helps a
patient's immune system recognize and destroy cancer cells more
effectively. Several types of immunotherapy are used to treat
patients with metastatic cancer, including cytokines, monoclonal
antibodies, and tumor vaccines. Most of these are still
experimental. These treatments are discussed in detail in American
Cancer Society documents on immunotherapy and the specific types of
cancer for which this approach is useful. For more information on
immunotherapy, please see "Immunotherapy."

Radiation Therapy

Radiation therapy uses high-energy rays or particles to destroy
cancer cells or slow their rate of growth. Radiation therapy can be
used to cure primary cancers that have not spread too far from their
original site. When a cancer has metastasized to bones, radiation is
used to relieve ( palliate ) symptoms.

External beam radiation: The most common way to deliver radiation to
a bone metastasis is to carefully focus a beam of radiation from a
machine outside the body. This is known as external beam radiation.
To reduce the risk of side effects, doctors carefully figure out the
exact dose and aim the beam as accurately as they can to hit the
target.

External beam radiation therapy for bone metastasis can sometimes be
given in one dose but most radiation oncologists (doctors who
specialize in radiation therapy) prefer to give the radiation in 5
to 15 doses. Each treatment lasts only a few minutes. External beam
radiation is an excellent option if you have 1 or 2 metastases that
are causing symptoms. But if there are many metastases scattered
throughout the body, treatment is more difficult. In rare cases,
some patients can benefit from radiation therapy of the entire upper
or lower half of their body. A few weeks later, the other half of
the body can be treated.

Internal radiation, interstitial radiation, or brachytherapy:
Another method of delivering radiation is to place (implant) metal
rods or tiny pellets (sometimes called "seeds") that contain
radioactive materials in or near the cancer. This method is called
internal radiation, interstitial radiation, or brachytherapy. This
approach is useful in treating some primary cancers and some
metastases, but it is not often used for treating bone metastasis.

For more information on radiation therapy, please see "Understanding
Radiation Therapy: A Guide for Patients and Families."

[my note: or ask Steph]