bone mets video
DESCRIPTION
These slides go with the you tube video found on www.aboutcancer.comTRANSCRIPT
Bone Metastases
Bone Metastases
Cancers that originate at another site (usually breast, prostate or lung) that spread to the bone are called bone metastases
Skeleton
Spine
Vertebrae
The bones in the spine are numbered
7 cervical
12 thoracic
5 lumbar
5 sacral
Spinal cord ends at T12-L1
Bone cancer in the spine can create problems if the tumor compresses the spinal cord inside the neural canal
Pain symptoms are related to the spot in the spine involved
MRI Spinal Metastases from Lung Cancer
The mets toL3 caused backPain radiatingInto the legs
MRI of the Lumbar Spine with Bone Destruction of L3 from Lymphoma
Bone Metastases
Origin: most common sites of origin (primary) are lung, breast, prostate and kidney
Symptoms: pain (esp at night), possible fracture or nerve compression , may cause elevated calcium level or lead to anemia
ribs
spine
pelvis
femurs
Most common sites for bone
metastases
Some bone mets make the bone look too white (osteoblastic)
others make dark holes (lytic)
Lytic = black hole in the bone
Blastic = abnormal white area
If not treated, lytic bone mets can cause considerable bone destruction
If the cancer has weakened the bone, it may be necessary to perform surgery prior to radiation to avoid a fracture
Blastic Bone Mets as seen on a CT scan
An MRI may show a bone met better than a regular X-ray
Bone Scan
A nuclear medicine (technitium) bone scan would show bone mets as dark areas
CT Scans show good bone detail
PET scans may show bone mets very clearly
PET Scans can be used to help targetthe radiation three dimensionally
PET showing the cancer pushing into the back of the right hip bone
Computer generated reconstruction showing the cancer in red and the radiation zone in orange
Bone met at L2
Radiation field
A typical course of radiation is 10 treatments ( in some cases it is necessary to go slower, 20 to 25 trips)
Side Effects of Radiation for Bone mets
•Mild fatigue
•Local skin irritation
•Lower the blood count (anemia or white count)
•The bone can temporarily get weaker before strengthening
Local Side Effects of Radiation for Bone mets
Sore throat or dry mouth
Trouble swallowing , heart burn or dry cough
Loose bowels or cramps
Bladder or rectal irritation
Radiation Results
•80 - 90% of the time the symptoms improve
•Complete relief in 54%
•Most respond by 10-14 days, 70% by 2 weeks, 90% by 3 months
•55 - 70% pain benefit is sustained for life
Can You Radiate a Bone Metastasis a second time if the cancer flares up?
Effectiveness of Reirradiation for Painful Bone Metastases: A Systematic Review and Meta-Analysis (IJROBP 2012:84:8)
Of the 2,694 patients initially treated for metastatic bone pain, 527 (20%) patients underwent reirradiation.
Overall, a pain response after reirradiation was achieved in 58% of patients
Xrays may take weeks to months to show improvement
PET scans can show response to radiationH&N squamous mets to L4
Before XRT 3 months after XRT
Same patient at 7 months, PET scan now totally back to normal
As the cancer shrinks (gray tissue) the bone can regrow
Bone Metastases to the Spine
Involved vertebrae on the left and normal on the right
Kidney cancer in the spinal vertebrae surrounding the cord, and appearance after radiation…is it possible to safely radiate further?
Radiation prescription for #
Diagnosis: #
Area Treated: #
Number of Treatments: #