Radiotherapy for bone pain
This page is about radiotherapy treatment to help relieve bone pain. You can find information about
Your doctor may suggest radiotherapy as a treatment to relieve bone pain caused by cancer that has spread into the bone. The areas of cancer cells in the bone are called secondary bone cancer, bone metastasis, or bony secondaries. Radiotherapy is often used to control pain due to bone secondaries from prostate cancer, breast cancer, bowel cancer and lung cancer. It may be combined with other types of treatment, depending on the type of cancer you have.
Radiotherapy can also help to make bones stronger and less likely to break. Secondary bone cancer weakens the bones by damaging healthy bone cells. Radiotherapy may be used to strengthen the bone. It can also treat bones that have fractured. After radiotherapy, some of the cancer cells die, so the bone begins to replace the lost tissue and becomes stronger, less painful, and less likely to break.
Radiotherapy for cancer that has spread to bones can also help to prevent new painful areas developing. Having this treatment may slow down the cancer and give you a better quality of life for a longer time. But it will not cure your cancer.
There are two main ways of giving radiotherapy for bone pain
External radiotherapy is the most common type of treatment if you have just one or two bone secondaries. The radiation beam is directed at the affected bone from outside the body. It is a bit like having an X-ray. You may have a single treatment or a series of short daily treatment sessions for up to 2 weeks.
If you have more than 1 or 2 areas of secondary bone cancer in different parts of your body, you may have external radiotherapy to the whole of your upper body and then, about 2 to 4 weeks later, treatment to the lower half of your body. This is called hemibody irradiation and allows your body to recover between treatments. To have this treatment you need to be quite fit and your bone marrow also needs to be working well.
If you have more than 1 or 2 areas of secondary bone cancer in different parts of your body, your doctor may suggest internal radiotherapy with radioisotopes. You have an injection of a very small amount of radioactive material called strontium 89. The affected areas of bone take up the strontium when it is injected. So the treatment targets where you need it most.
The radiation from the injection only lasts a few days in your body. It is only a small amount of radiation, but can work very well for controlling bone pain. There is detailed information about radioactive strontium treatment in the internal radiotherapy section.
External radiotherapy for bone pain can ease the pain to some extent or may get rid of it altogether. The radiation kills off cancer cells that are destroying and weakening the bone. It may take several weeks to work fully.
About 3 out of 10 people (30%) will have no pain within a month of radiotherapy treatment. For at least another 4 out of 10 (40%) people, the treatment reduces the pain by half. So at least 7 out of 10 people (70%) will have somewhere between no pain and half as much pain, after their radiotherapy treatment.
By about 6 to 12 weeks after treatment the bones have repaired the damage caused by the cancer cells and they get stronger.
Studies of hemibody irradiation show that it gives nearly everyone some pain relief. It can relieve pain completely in up to half of the people treated. It can also help to stop new painful areas developing.
Strontium treatment takes between 1 and 4 weeks to start to reduce pain. The pain relief may last for up to 18 months. A review in the Lancet found that between 40 and 95 out of every 100 people treated (40 to 95%) have pain relief from this type of treatment.
You need to carry on taking your painkillers in the meantime. But within a few weeks, sometimes less, you may be able to cut down on the amount of painkillers you take. If you are getting more side effects from your painkillers, such as feeling drowsy, it may be a sign that you don’t need to take as many. So let your doctor or nurse know and they can advise you about how to safely reduce your painkillers.
If your first course of palliative radiotherapy doesn't work well, your doctor may recommend that you have a second course. You may also have a second course if the pain gets better, but then comes back again. The SC20 trial is looking at how well a second course of radiotherapy works for cancer that has spread to the bone. And it wants to find out what the best dose is. You can find details on our clinical trials database.
Radiotherapy for bone pain aims to relieve symptoms, and so doctors aim not to cause many side effects. So the side effects with this treatment are usually mild. There is information below about
- Side effects of external palliative radiotherapy
- Side effects of hemibody irradiation
- Side effects of strontium injection
The side effects of external palliative radiotherapy depend on which part of the body is treated. But this type of treatment usually has few side effects. You may feel tired and your skin may get red in the treatment area.
You may feel sick if you are having treatment to your ribs, if your stomach is in the treatment area, or if you are having treatment to the skull. To help control this, your doctor or nurse can give you anti sickness drugs (anti emetics). You may find that taking an anti sickness tablet an hour before your treatment helps. If you are having treatment to your hips (pelvis), or if your bowel is in the treatment area, you may have some diarrhoea. Your doctor or nurse can give you medicines to help control this.
The side effects tend to come on gradually as you go through your treatment course and may last for a week or two after the treatment has finished.
With hemibody irradiation, you are likely to feel sick. So to prevent this, your doctor or nurse can give you anti sickness medicines and steroids before your treatment. The treatment may also slow the production of blood cells by your bone marrow. So you may get anaemic and have an increased risk of infection. But this is temporary. Your doctors will keep an eye on your blood cell counts when you have your check ups.
There are very few side effects with strontium 89 treatment. You will have some radioactivity in your body for a while after the treatment. But the amount is extremely small and gets lower each day. Your doctor or nurse will let you know if there are any safety guidelines you need to follow after your treatment. How long you have to follow these for will depend on the dose of strontium you have had.
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