Effective treatment of the primary cancer is the best way to manage bone metastases. In addition to the cancer treatment, there are a variety of treatment options available for bone metastasis.

Bisphosphonates. Bisphosphonates are drugs that slow the bone damage caused by metastases. They are used to decrease the risk of bone complications like fractures and to lower abnormally high blood calcium levels. Data also suggest that treatment with bisphosphonates can also reduce the bone pain associated with bone metastasis.

Different types of bisphosphonates are available and include etidronate, clodronate, pamidronate, ibandronate, and zolendronic acid. Bisphosphonates exist in both oral and intravenous (IV) forms. IV bisphosphonates are more commonly used for the treatment of bone metastasis. The side effects of bisphosphonate treatments are usually mild and do not last long. They include tiredness, nausea, vomiting, lack of appetite, or transient bone pain.

Studies with bisphosphonates have demonstrated their efficacy in patients with bone metastasis from various solid tumors including breast, prostate, lung and other cancers, as well as in patients with multiple myeloma. Investigators are also looking at whether bisphosphonates can also prevent the development or recurrence of bone metastases.

Chemotherapy and hormone therapy. Chemotherapy is a form of cancer treatment which uses drugs to kill cancer cells throughout the body. The drugs for this cancer treatment may be taken orally or given intravenously. Hormone therapy uses drugs to prevent hormones from forming or acting on cells to promote cancer growth. (For example, hormones such as estrogen in women can promote the growth of some cancers, such as breast cancer.) The cancer treatment goals of chemotherapy and hormone therapy in patients with bone metastases are to control the tumor's growth, thus potentially reducing the risk of associated bone complications.

Radiation therapy. Radiation is useful in relieving pain and controlling the growth of tumor cells in the area of the bone metastasis. It may be used to prevent a fracture or as a treatment for spinal cord compression.

Radiation therapy uses high-energy ionizing radiation to injure or destroy cancer cells. Typically radiation is administered once a day in 10 treatments over a 2-week period. Full effects of this cancer treatment may take 2 to 3 weeks to occur. Side effects of radiation therapy may include skin changes in the area of treatment and a temporary increase in symptoms of bone metastasis.

Another type of radiation therapy is called radiopharmaceutical therapy. This approach involves injecting into a vein a radioactive substance such as strontium-89. This substance is attracted to areas of bone containing cancer. Providing radiation directly to the bone in this way destroys active cancer cells in the bone and can relieve symptoms. Two important side effects of this cancer treatment are decreased blood counts with increased risk of bleeding, and rarely, leukemia.1

Surgery. Surgical treatment for bone cancer is done to prevent or to treat a bone fracture. It usually involves removing the tumor and stabilizing the bone to prevent a fracture. Metal rods, plates, screws, wires, nails, or pins may be surgically inserted to strengthen or provide structure to the bone damaged by metastasis.

Other therapies. Other treatments for bone metastases and their symptoms include physical therapy and drug and nondrug approaches to control pain. Many different drugs or combinations of drugs can be used to treat pain from bone metastases. The principal drug type used to treat bony metastases is the non-steroidal anti-inflammatory agents (including aspirin, ibuprofen, naproxen, and prescription drugs), which stop prostaglandins. Prostaglandins seem to be responsible for much of the bony pain. It is important to take these medicines with food or milk to protect the stomach. Nondrug approaches to managing pain include the use of heat and cold, relaxation techniques, and therapeutic beds or mattresses.

Clinical trials are exploring other treatments to better manage bone metastases.

References:

1. Kossman SE, Weiss MA. Acute Myelogenous Leukemia After Exposure to Strontium-89 for the Treatment of Adenocarcinoma of the Prostate Cancer. 2000;88:620-624.

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