About radiotherapy for secondary bone cancer

Radiotherapy uses high-energy rays to treat cancer. It works by destroying cancer cells in the area that is being treated.

Normal cells can also be damaged by radiotherapy. But they can usually repair themselves, while cancer cells cannot.

Radiotherapy is often used to treat secondary bone cancer. It can help relieve symptoms such as pain.

You may have:

  • External beam radiotherapy. This aims high-energy x-rays at the affected bone from a radiotherapy machine.
  • Radioisotope therapy (or radionuclide therapy), where you have a radioactive substance either as a capsule or as an injection into a vein.

External beam radiotherapy

You may have radiotherapy for secondary bone cancer as:

  • a single treatment session
  • a number of treatment sessions, which are given daily.

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

You will normally have radiotherapy to the area of the bone affected by the cancer. It usually takes 7 to 10 days for radiotherapy to start reducing bone pain. It may take up to 6 weeks before you feel the full effect. You may notice that any pain you have becomes slightly worse before getting better.

During this time, it is important to continue taking the painkillers your doctor prescribes. As your pain improves, you may be able to reduce the amount of painkillers. It is important to talk to your doctor or nurse before adjusting the dose.

External radiotherapy does not make you radioactive. It is perfectly safe to be with other people after treatment, including children.

Side effects of external radiotherapy

This type of radiotherapy usually causes very few side effects. However, treatment to bones in certain areas of the body, such as the ribs or the spine, may make you feel sick for a couple of days after the treatment. Radiotherapy treatment to your pelvis may cause diarrhoea. These side effects can usually be prevented by taking anti-sickness or anti-diarrhoea medicines.

Before your treatment starts, your doctor, nurse or radiographer (who gives the radiotherapy) will discuss any likely side effects with you. They will also arrange for you to have any drugs you may need to manage these side effects.

We have more general information about radiotherapy.

 

Stereotactic ablative radiotherapy

This type of radiotherapy is very precise. It uses many small beams of radiation to target the tumour. It is occasionally used to treat secondary bone cancer in the spine if there are only one or two areas affected.

This treatment is not widely available in the UK, and you may need to be referred to a specialist hospital. If your doctor thinks it is a suitable treatment for you they will give you more information about it.

We have more information about stereotactic radiotherapy.

Radioisotope therapy

Radioisotopes are radioactive substances. These may be given as a drink, capsules, or as an injection into a vein. Cancer cells absorb radioisotopes more than normal cells and so get a higher dose of radiation. This causes the cancer cells to die.

The advantage of radioisotope treatment is that all the bones affected by cancer will be treated. So, it can be a helpful treatment if several of your bones are affected.

There are different types of radioisotopes. The type you have will depend on the type of primary cancer you have.

Radium 223 (Xofigo®)

Radium-223 is a type of radioisotope therapy.

You may have radium-223 to treat secondaries in the bone from prostate cancer that is no longer responding to hormonal therapy. It can help improve symptoms and may help you to live longer.

You have it as an injection through a small tube (cannula) which is put into a vein in your arm or hand. You usually have the injection every 4 weeks, up to 6 times. You will normally have the injection as an outpatient. This means you will be able to go home afterwards.

Your pain may get worse for a few days after your treatment. Your doctor can prescribe extra painkillers if you need them. The pain usually improves over the following few weeks.

Your urine and blood will be very slightly radioactive for about 7 days and you will be given advice to follow to reduce any risk to others.

Stronium-89 and Samarium-153

Strontium-89 and samarium-153 are types of radioisotope therapy.

You may occasionally have strontium-89 to treat secondaries in the bone from prostate cancer and breast cancer. You have it as an injection through a small tube (cannula) which is put into a vein in your arm or hand. You will normally have the injection as an outpatient and be able to go home afterwards.

Samarium-153 may also be used to treat secondaries in the bone.

Your doctor or specialist nurse will give you more information about these treatments if they are suitable for you.

Iodine-131

Iodine-131 is a type of radioisotope therapy.

You may have iodine-131 to treat secondaries in the bone from thyroid cancer. You will be given the radioactive iodine as a capsule or occasionally as a drink.

The radioactivity in iodine-131 breaks down slowly, so 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 is safe for other people around you.

Side effects of radioisotope treatment

Radioisotopes such as radium-223 or strontium-89 can temporarily reduce the number of normal red and white blood cells produced by the bone marrow.

If the number of your red blood cells is low (anaemia), you may feel tired and breathless. You may be given a blood transfusion if they are very low. When your number of white blood cells is low you are more prone to infection. If you develop an infection you will be given antibiotics.

Another side effect can be tumour flare which is swelling around the tumour area in the days following treatment. This can cause a temporary increase in pain and tenderness, and you may need to take painkillers for a few days.