Purpose of review: This review addresses the latest advances in radiation treatment for cancer pain.
Recent findings: There is reluctance worldwide to adopt single fraction radiotherapy as standard practice. This is well summarized by a review article reporting on surveys on practice patterns among radiation oncologists worldwide. It was suggested by the Tasman Radiation Oncology Group trial, however, that patients with neuropathic pain may need multiple treatments. Patients with bone metastases may outlive the benefits of palliative radiation and require re-irradiation. A recent report from the Dutch Bone Metastasis Study confirmed the effectiveness of re-irradiation in both responders and nonresponders to initial radiation therapy. Effects of palliative radiotherapy on function and quality of life have been explored in various studies but with disparate conclusions. This may stem from a lack of a good, patient-based instrument with which to measure quality of life. A project by the European Organisation for Research and Treatment of Cancer Quality of Life Group is currently under way to develop a bone metastases module. Patients receiving single fraction radiotherapy may be at greater risk for pain flare.
Summary: Patients with uncomplicated bone metastases can be effectively palliated with single fraction radiotherapy.