Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands and Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland.
Radiother Oncol. 2022 Aug;173:197-206. doi: 10.1016/j.radonc.2022.05.024. Epub 2022 May 31.
After liver and lungs, bone is the third most common metastatic site (Nystrom et al., 1977). Almost all malignancies can metastasize to the skeleton but 80% of bone metastases originate from breast, prostate, lung, kidney and thyroid cancer (Mundy, 2002). Introduction of effective systemic treatment in many cancers has prolonged patients' survival, including those with bone metastases. Bone metastases may significantly reduce quality of life due to related symptoms and possible complications, such as pain and neurologic compromise. The most serious complications of bone metastases are skeletal-related events (SRE), defined as pathologic fracture, spinal cord compression, pain, or other symptoms requiring an urgent intervention such as surgery or radiotherapy. In turn, growing access to modern diagnostic tools allows early detection of asymptomatic bone metastases that could be successfully managed with local treatment avoiding development of SRE. The treatment for bone metastases should focus on relieving existing symptoms and preventing new ones. Radiotherapy is the standard of care for patients with symptomatic bone metastases, providing durable pain relief with minimal toxicity and reasonable cost-effectiveness. Historically, the dose was prescribed in one to five fractions and delivered using simple planning techniques. While 3D-conformal radiotherapy is still widely used for treating bone metastases, introduction of highlyconformal radiotherapy techniques such as stereotactic body radiotherapy (SBRT) have opened new therapeutic possibilities that should be considered in selected patients with bone metastases.
继肝脏和肺部之后，骨骼是第三大常见的转移部位（Nystrom 等人，1977 年）。几乎所有的恶性肿瘤都可以转移到骨骼，但 80%的骨转移来自于乳腺癌、前列腺癌、肺癌、肾癌和甲状腺癌（Mundy，2002 年）。许多癌症的有效全身治疗方法的引入延长了患者的生存时间，包括那些有骨转移的患者。骨转移可能会因相关症状和可能的并发症（如疼痛和神经功能障碍）而显著降低生活质量。骨转移最严重的并发症是骨骼相关事件（SRE），定义为病理性骨折、脊髓压迫、疼痛或其他需要紧急干预（如手术或放疗）的症状。反过来，越来越多的现代诊断工具的应用使人们能够早期发现无症状的骨转移，这些转移可以通过局部治疗成功控制，从而避免 SRE 的发生。骨转移的治疗应侧重于缓解现有症状和预防新的症状。放射治疗是治疗有症状的骨转移患者的标准治疗方法，它具有持久的止痛效果，毒性极小，具有合理的成本效益。从历史上看，剂量被规定为一次到五次分割，并使用简单的计划技术进行治疗。虽然 3D 适形放疗仍然广泛用于治疗骨转移，但高度适形放疗技术（如立体定向体放疗（SBRT））的引入为骨转移患者提供了新的治疗选择，这些选择应在特定患者中进行考虑。
