Radiation therapy in three of four cases relieves pain in patients with bone metastases. However, according to X-ray data, bone calcification processes are rarely observed. Some metastases are particularly difficult to respond to radiation.
These include, for example, large metastases to the cortical layer of the femur, and metastases to other bones that perform basic support functions. In such cases, it is often necessary to combine radiation therapy with orthopedic fixation of the bone in order to avoid pathological fractures. Particular attention should be paid to metastases in the chest bone.
If the appropriate measures are not taken, the chest becomes fragile, and a fracture of the mid-spinal section of the spine can occur, which is life-threatening. In 15% of patients with breast cancer metastases are observed in the brain. At the same time, radiation therapy is effective in approximately two thirds of cases, and thus, it is often possible to control the process of metastasis until the patient dies.
In many cases, there is a shift of the vertebrae and pinching of the nerve endings, the possible treatment methods for which are discussed in a separate article on the site (we recommend using the search form on the home page of the site). In premenopausal patients, irradiation of the pelvic area in a relatively small dose leads to a complete and prolonged amenorrhea.
Therefore, radiation, after which the state of menopause develops, is used as an alternative to surgical removal of the ovaries, especially in patients who, by the general condition of the body, surgery is contraindicated. The likelihood of developing complete amenorrhea depends on the magnitude of the radiation dose, and fractional irradiation is usually carried out (dose 10–15 Gy, five fractions per week).
The state of menopause that develops after irradiation alleviates symptoms as much as surgical removal of the ovaries. Clinical manifestations of metastasis to the skin, lymph nodes, the pelvic region, or to the liver are often weakened by local irradiation; this is observed even in cases where systemic treatment is ineffective.
If a local recurrence occurs after mastectomy, radiation therapy should be used if it has not been performed previously. However, often local recurrences occur against the background of systemic metastases, and if there are indications for wider systemic treatment, it is often more appropriate.
Even in this case, radiation therapy may be the best method of treatment for localized tumor recurrences. If after the operation, radiation therapy was performed, then additional irradiation is undesirable, as local structures such as the brachial plexus, skin and lungs have already received a certain dose of radiation. In such difficult cases, local electron beam irradiation or a hyperthermia session may be helpful.