Authors Eva Pribožič Univerzitetni klinični center Maribor Ivica Ratoša Onkološki inštitut Ljubljana; Univerza v Ljubljani, Medicinska fakulteta Jasna But-Hadžić Onkološki inštitut Ljubljana; Univerza v Ljubljani, Medicinska fakulteta DOI: https://doi.org/10.25670/oi2023-008on Keywords: bone metastases, pain, palliative radiotherapy, fractionation, pathologic fracture, malignant spinal cord compression Abstract

Kostni zasevki povzročajo bolečino, ki vpliva na kakovost življenja bolnika in lahko vodijo do zapletov, ki zahtevajo urgentno ukrepanje. Ko zaradi kostnih zasevkov grozi oziroma je prisoten patološki zlom ali maligna kompresija hrbtenjače, je nujno oceniti, ali bolnik potrebuje kirurško intervencijo, ki ji sledi pooperativno obsevanje. Kadar bolnik ni kandidat za operativno zdravljenje, se priporoča urgentno obsevanje. Pri bolečih kostnih zasevkih, brez grozečega oziroma prisotnega patološkega zloma ali maligne utesnitve hrbtenjače, ne glede na velikost samega zasevka, prvi pristop zdravljenja bolečine predstavlja farmakološko zdravljenje, ki ga podpre in dopolni protibolečinsko paliativno obsevanje. Pri paliativnem obsevanju so celokupne obsevalne doze nizke, obsevanje je izvedeno v enem odmerku ali v kratkih obsevalnih režimih. Bolniki, ki ne odgovorijo na prvo obsevanje, ali se jim bolečina ponovi, so lahko varno ponovno obsevani na istem mestu. Na Onkološkem inštitutu Ljubljana smo opravili retrospektivni pregled paliativnih obsevanj kosti med leti 2018 – 2021. Letno obsevamo 800 kostnih zasevkov, upažamo pa upad števila obsevanj. Najpogostejša frakcionacija je 5 x 4 Gy, samo 10% bolnikov pa prejme obsevanje v enem odmerku. Protibolečinsko obsevanje kosti je učinkovito, stroškovno učinkovito in varno. Pomembno je prepoznati bolnike, ki bi imeli korist od protibolečinskega obsevanja, in jih napotiti na konzilij. S poenostavitvijo radioterapevtskih postopkov in odločitvijo za obsevanje v enem odmerku, je lahko obsevalno zdravljenje bolniku prijaznejše in dostopnejše.

Abstract (Eng)

Bone metastases cause pain and impair quality of life, and they can lead to serious complications that require immediate treatment. Urgent surgical treatment followed by postoperative radiotherapy should be considered in bone metastases with an impending or existing pathologic fracture or spinal cord compression. Patients who are unable or unwilling to undergo surgery should be referred for urgent radiotherapy. Patients with painful bone metastases without an impending or existing pathologic fracture and no spinal cord compression, regardless of the size of the metastatic lesion, are treated pharmacologically first, complemented by palliative irradiation. In palliative radiation, low total doses are prescribed and delivered in a single fraction or in short fractionation regimens. Patients with insufficient pain relief or pain relapse after initial radiation can be safely reirradiated. We conducted a retrospective review of palliative bone irradiations between 2018 – 2021 at the Institute of Oncology Ljubjana. Annually, we treat 800 bone metastases and we are seeing a decline in the number of irradiations. The most common fractionation is 5 x 4 Gy, with only 10% of patients receiving single-dose treatment. Palliative irradiation for painful bone metastases is effective, inexpensive, and safe. It is critical to select patients who will benefit from radiation therapy and present them in a multidisciplinary team meeting. Radiation treatment can be made easier to use by simplifying the procedure for the patient and prescribing the dose in one fraction.

How to Cite

Pribožič, E., Ratoša, . I., & But-Hadžić, J. (2023). Radiation therapy for painful bone metastases . Onkologija : A Medical-Scientific Journal, 27(2), 40–46. https://doi.org/10.25670/oi2023-008on

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Copyright (c) 2023 Eva Pribožič, Ivica Ratoša, Jasna But-Hadžić

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