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Is there an indication to do palliative Rt for secondary lytic bone lesion , with no pain but with a risk of fracture ? So the aim would be reducing risk of fx instead od treating pain symptoms?
No. Radiation does not change the mechanics of a fracture. However, could consider surgical fixation followed by post-op XRT if warranted.
No. Radiation does not change the mechanics of a fracture. However, could consider surgical fixation followed by post-op XRT if warranted.
May I know the rationale for treating a painless lesion with <50% erosion?I would disagree with a blanket statement like that. IMO, standard practice breakdown is as follows: >50% of cortical bone width erosion --> surgery; <50% --> XRT. The latter applies to painless lesions in weight-bearing bones.
Yup, if the mirel score is high and ortho says no, I'll treat with XRT anyways. A met will eventually re-mineralize once the cancer is treated with XRTI would disagree with a blanket statement like that. IMO, standard practice breakdown is as follows: >50% of cortical bone width erosion --> surgery; <50% --> XRT. The latter applies to painless lesions in weight-bearing bones.
May I know the rationale for treating a painless lesion with <50% erosion?
I actually agree with Gfunk - As far as I understand, XRT does not restore stability/decrease fracture risk.
If so, and if there is no pain, what is the benefit of XRT?
I guess it depends on whether the patient is going to receive systemic treatment, and if RT will delay that. If the patient needs RT to another site anyway, I would accept your argument.If you believe a painless lesion with >50% erosion warrants fixation, then it's pretty clear why you would treat a lesion with <50% erosion...to prevent it from becoming more than 50% erosive. Do this all the time for femur lesions that are concerning when I'm radiating other bone mets. You don't go chasing these patients down or get referrals for them, but a lesion has to grow to get to the point of being a threat for fracture, and you can halt/slow that progression. It doesn't need to remineralize, it just needs to not progress...
Agreed.Do we evidence for everything?
I can tell you prima facie that a bone with a treated met stands a better chance of remineralizing than one harboring an untreated, actively growing met.
Nonetheless... http://www.ncbi.nlm.nih.gov/pubmed/10554645
I agree that if I see a patient for just about any reason and notice a moderate sized femoral met, I'm more likely than not to treat it even if it doesn't hurt. What's the downside? The up side is potentially preventing a devastating hip fracture that spells curtains for a patient's QOL and often kills them.