Kibe Yuichi, Nakamura Naoki
Department of Radiation Oncology, JR Tokyo General Hospital, Tokyo, Japan.
Radiation Oncology Division, St. Marianna University School of Medicine Hospital, 16-1 Sugao Miyamae-ku, Kawasaki-shi, Kanagawa-ken, 216-8511, Japan.
Int J Clin Oncol. 2025 Jun 6. doi: 10.1007/s10147-025-02795-1.
Conventional external beam radiotherapy (cEBRT) is effective for managing symptomatic bone metastases and continues to be in demand despite advances in stereotactic body radiotherapy. This review provides an overview of cEBRT for bone metastases, with a focus on the following: (1) Initial palliative radiotherapy: randomized controlled trials and meta-analyses have shown that single-fraction cEBRT at 8 Gy is as effective as multifractionated cEBRT for reducing pain due to bone metastases. Single-fraction cEBRT at 8 Gy may be a reasonable option for bone metastases with neuropathic pain in consideration of the burden on patients. The efficacy of radiotherapy for preventing skeletal-related events in bone metastases remains unclear. Prophylactic fixation followed by radiotherapy is recommended for long-bone metastases at high risk of fracture. (2) Palliative reirradiation: reirradiation is indicated for patients with insufficient pain relief or pain progression after initial radiotherapy for bone metastases. In palliative reirradiation for spinal metastases, the tolerance dose of the spinal cord needs to be carefully considered due to the risk of radiation myelitis. (3) Treatment strategies for metastatic spinal cord compression (MSCC) or spinal bone metastases with instability: treatment decisions for MSCC, including radiotherapy or decompression surgery followed by radiotherapy, need to be carefully considered by a multidisciplinary team, including radiation oncologists and orthopedic surgeons. Moderate-dose corticosteroids (dexamethasone bolus of 10-16 mg) are recommended in combination with radiotherapy for MSCC. Spinal instability caused by spinal bone metastases is an indication for fixation surgery, and postoperative radiotherapy needs to be considered.
传统外照射放疗（cEBRT）在治疗有症状的骨转移方面是有效的，尽管立体定向体部放疗有所进展，但仍有需求。本综述概述了cEBRT治疗骨转移的情况，重点如下：（1）初始姑息性放疗：随机对照试验和荟萃分析表明，8 Gy单次分割cEBRT在减轻骨转移引起的疼痛方面与多次分割cEBRT效果相同。考虑到患者的负担，对于伴有神经性疼痛的骨转移，8 Gy单次分割cEBRT可能是一个合理的选择。放疗预防骨转移中骨相关事件的疗效仍不明确。对于骨折高危的长骨转移，建议先进行预防性固定，然后放疗。（2）姑息性再程放疗：对于骨转移初始放疗后疼痛缓解不足或疼痛进展的患者，可进行再程放疗。在脊柱转移瘤的姑息性再程放疗中，由于存在放射性脊髓炎的风险，需要仔细考虑脊髓的耐受剂量。（3）转移性脊髓压迫（MSCC）或伴有不稳定的脊柱骨转移的治疗策略：MSCC的治疗决策，包括放疗或减压手术加放疗，需要由包括放射肿瘤学家和骨科医生在内的多学科团队仔细考虑。对于MSCC，建议联合放疗使用中等剂量的皮质类固醇（地塞米松推注10 - 16 mg）。脊柱骨转移引起的脊柱不稳定是固定手术的指征，术后需要考虑放疗。
