Radiotherapy for secondary bone cancer

The treatment is given in the hospital radiotherapy department. It is the most common type of treatment for secondary bone cancer as it is very effective for relieving symptoms| such as pain or swelling.

Radiotherapy is usually given by aiming high-energy x-rays at the affected bone from a radiotherapy machine. This is known as external beam radiotherapy. Sometimes a type of internal radiotherapy called a radioisotope is used.

External beam radiotherapy Back to top

Radiotherapy for secondary bone cancer can be given in different ways. Sometimes a single dose is given. This has the advantage that you will only need to make one visit to the radiotherapy department. Sometimes your treatment may be divided into a number of sessions. Each session is known as a fraction.

The way in which your treatment is given will depend on the type of cancer (the primary) and where it is in the body.

Your doctor will discuss your treatment with you beforehand and answer any questions you have.

Radiotherapy is normally given to just the area of the bone affected by the cancer. However, if the cancer is in several areas of bone, your doctors may suggest treating a larger area. They may refer to this as hemibody irradiation, which means treating half the body.

It usually takes 7-10 days for radiotherapy to start reducing the pain and it may take up to six weeks before you feel the full effect. You may notice that the pain becomes slightly worse before getting better. During this time it’s important to continue taking the painkillers prescribed by your doctors. As the pain improves, it may be possible to reduce the amount of painkillers. It’s a good idea to discuss this with your doctor or nurse before adjusting the dose.

Side effects

Usually this type of radiotherapy causes very few side effects. However, treating bones in certain areas of the body, such as the ribs or the spine, may cause some sickness| for a day or so after the treatment. This can usually be prevented by taking anti-sickness (anti-emetic) tablets. Before the treatment starts your doctor, nurse or radiographer (who gives the radiotherapy) will discuss with you any likely side effects.

Radioisotopes Back to top

Radioisotopes are substances which are mildly radioactive. Some radioisotopes are taken up (absorbed) by bone and they can sometimes be used to treat secondary bone cancers.

The radioisotope is usually given as a liquid injected into a vein, usually in the arm.

The radioisotope travels through the bloodstream to the bones, where it gives a dose of radiotherapy to the areas affected by the cancer cells. This can help to reduce pain, often within a few days, but sometimes it will take a few weeks to start working.

The advantage of radioisotope treatment is that all the bones in the body affected by cancer will be treated. This makes it an ideal treatment if a number of your bones are affected. However, it is only suitable for treating secondary cancers (secondaries) from certain types of primary cancer.

For instance:

• an injection of strontium-89 may be used to treat secondaries from cancer of the prostate or breast
• secondaries from cancer of the thyroid may be treated with iodine-131.

Strontium-89

A single injection is given through a small tube (cannula) inserted into a vein. People are normally given the injection as an outpatient. Pain caused by the cancer is normally reduced several weeks after the injection. In most people the pain relief lasts for several months. The treatment is sometimes repeated if the pain comes back. After the injection of strontium-89, it is safe to be with other people, including children. However, your urine and blood will be very slightly radioactive for about seven days afterwards. You will be given advice to follow to reduce any risk to others.

Iodine-131

This is given as a treatment for bone secondaries from thyroid cancer. The iodine is given as a capsule that is swallowed, or as an odourless, colourless drink. If the iodine is used as a treatment for other types of cancer, or if it’s attached to another chemical, it is likely to be given as a drip (intravenously) over a period of up to one hour.

The radioactivity in iodine-131 breaks down slowly and you will need to stay in hospital in a single room for a few days. You can go home once the radioactivity reduces to a level that’s safe enough to allow you to be with other people.

You may need to take some special precautions for a short time after going home, such as avoiding spillages of urine. The hospital staff will explain these to you.

Side effects

Radioisotopes such as strontium-89 can temporarily reduce the number of normal red and white blood cells produced by the bone marrow. When the number of white blood cells is low, you’re more prone to infection|. If necessary, you’ll be given antibiotics to treat any infection. If the number of red blood cells is low (anaemia), you may get tired easily. If the number of red blood cells is very low you may be given a blood transfusion.

Tumour flare may occur - this is swelling around the tumour area in the days following treatment. It can cause a temporary increase in pain and tenderness and you may need to take painkillers for a few days.