The failures and challenges of bone metastases research in radiation oncology.

Bone metastases affect a large portion of the cancer population. As treatment options continue to evolve, many added failures and challenges arise. This narrative review details such in palliative radiation therapy for bone metastases. We begin by describing the incidence rates of bone metastases in the cancer population, the current standards of practice in recent literature and clinical trial data. Inconsistencies in end point definitions along with difficulties in measuring response to treatment and controversial areas are outlined. Current literature suggests that there is a discrepancy in physician and patient perspective on treatment options as well as quality of life. The added challenges of treatment side effects are addressed and a review of recent trials is given. Stereotactic radiation therapy is a relatively new treatment option for patients with bone metastases. Therefore, a review of the safety and efficacy of this treatment is provided. Other new areas of bone metastases treatment and research such as high intensity focused ultrasound and nanoparticles are discussed. Physicians need to prevent unwanted side effects of treatment in addition to determining how to integrate many new upcoming treatment options for patients with bone metastases. A continued reluctance to practice evidence based medicine needs to be addressed.