The Role of Post-Operative Radiotherapy for Non-Spine Bone Metastases (NSBMs)

SIMPLE SUMMARY: Many cancers can metastasize to bones and require surgical intervention to repair or prevent fractures. Radiation post-surgery has become a standard treatment to reduce the risk of local tumor recurrence. This article reviews the use of radiation after surgery for bone metastases outside of the spine. We discuss prior research and common practice patterns in this field. We found that post-operative radiation can reduce the risk that cancer will return to the same area and can improve patients’ pain and function. Radiotherapy treatments are commonly delivered in five to ten treatments and should ideally encompass the entire hardware inserted at the time of surgery. Studies suggest that timely radiation therapy can lead to improved outcomes for patients. The specific treatments utilized should be guided by both patient and disease factors. Further studies are needed to help guide the specific radiation techniques and doses that are used. ABSTRACT: Non-spine bone metastases (NSBMs) can cause significant morbidity and deterioration in the quality of life of cancer patients. This paper reviews the role of post-operative radiotherapy (PORT) in the management of NSBMs and provides suggestions for clinical practice based on the best available evidence. We identified six retrospective studies and several reviews that examined PORT for NSBMs. These studies suggest that PORT reduces local recurrence rates and provides effective pain relief. Based on the literature, PORT was typically delivered as 20 Gy in 5 fractions or 30 Gy in 10 fractions within 5 weeks of surgery. Complete coverage of the surgical hardware is an important consideration when designing an appropriate radiation plan and leads to improved local control. Furthermore, the integration of PORT in a multidisciplinary team with input from radiation oncologists and orthopedic surgeons is beneficial. A multimodal approach including PORT should be considered for an NSBM that requires surgery. However, phase III studies are needed to answer many remaining questions and optimize the management of NSBMs.