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Radiotherapy for pain in the bone

Radiotherapy can help relieve pain from secondary cancer in the bone. Secondary cancers are cancers that have spread from another part of the body. 

Secondary cancer in the bone

Secondary bone cancer weakens bones and can be very painful. This can make them more likely to fracture if you have a fall. Sometimes they might even break during everyday activities. 

Radiotherapy to control bone pain

You might have radiotherapy to control pain from secondary bone cancer. It may be combined with other types of treatment, depending on the type of cancer you have.

Radiotherapy can help prevent your bones from fracturing. It can also help to prevent new painful areas developing.

Having this treatment might slow down the cancer and give you a better quality of life for a longer time. But it won't cure your cancer. Treatment that aims to relieve your symptoms is called palliative radiotherapy. 

How you have treatment

Both external and internal radiotherapy can help with bone pain.

More rarely you might have hemibody irradiation. This is a type of external radiotherapy. 

External beam radiotherapy

External radiotherapy is the most common type of treatment for secondary bone cancer. 

Before you start your treatment you have a specialised CT planning scan so the treatment team can plan exactly where to give the radiotherapy. You might also need to have a plastic mould made to keep you still during the treatment sessions.

To have the treatment you lie on a radiotherapy couch. The radiographers (sometimes called radiotherapists) help you to get into the right position.

External radiotherapy machine

Once you are in the right position the staff leave you alone in the room. This is so they are not exposed to radiation. You will be alone for a few minutes. The radiographers can see and hear you the whole time. 

You can't feel the radiotherapy. It doesn’t hurt but you may find it uncomfortable to lie in position during the treatment because the the radiotherapy couch can be quite hard. Ask your doctor or specialist nurse if you can take a painkiller half an hour beforehand if you think it might help.

You might have a single treatment or a series of daily treatment sessions, Monday to Friday for up to 2 weeks.

Hemibody irradiation

You might have hemibody irradiation if you have a lot of areas of secondary bone cancer.

Hemibody irradiation involves having external radiotherapy to the whole body. You have radiotherapy to the upper body and then 2 to 4 weeks later you have treatment to your lower body. 

To have this treatment your bone marrow needs to be working well. It is an uncommon treatment these days.

Internal radiotherapy with radiotherapy liquids (nuclear medicine)

Your doctor might suggest internal radiotherapy with radioactive liquids (nuclear medicine) for cancer in the bone that has spread from the prostate. You might have radioactive strontium or radium 223.

You have them as an injection. They are picked up by the cancer cells in the bone. The liquid then releases radiation to the areas of cancers. 

The radiation from the injection only lasts a few days in your body. It is only a small amount but can help to control bone pain. 

Side effects

The side effects with this treatment are usually mild. Radiotherapy for bone pain aims to relieve symptoms and so the amount of radiotherapy you receive is usually low. Different treatments cause different side effects. 

The side effects of external palliative radiotherapy depend on which part of the body is treated. This type of treatment usually has few side effects including:

  • feeling tired
  • your skin may get red in the treatment area
  • treatment can cause a flare up of pain for 1 or 2 days and you may need painkillers to help
  • feeling sick if you are having treatment to your ribs, your stomach area, your pelvic area or your skull – your doctor or nurse can give you anti sickness drugs (anti emetics) and taking them an hour before your treatment might help
  • having diarrhoea with treatment to your hips (pelvis), or bowel area – you can have medicines to reduce diarrhoea

The side effects tend to come on gradually as you go through your treatment course. They 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 might also slow the production of blood cells by your bone marrow. So you might not have enough red blood cells (anaemic) and have an increased risk of infection. This is temporary.

Your doctors will keep an eye on your blood cell levels when you have your check ups.

There are very few side effects with strontium 89 treatment or radium 223 therapy. 

You have some radioactivity in your body for a while after the treatment. 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 depends on the dose of treatment that you had.

Last reviewed: 
22 Jan 2019
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    Peter Hoskin
    Oxford University Press, 2012

  • Devita, Hellman and Rosenberg's Cancer Principles and Practice of Oncology (10th edition)
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    Wolters Kluwer Health, 2015

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    P Hoskin, C Coyle
    Oxford University Press, 2011

  • Walter and Miller's Textbook of Radiotherapy: Radiation Physics, Therapy and Oncology (7th edition)
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    Elsevier LTD, 2012

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