Radiotherapy for pain relief in patients with untreatable secondary cancer tumours

Secondary cancer tumours (metastases) located in bone tissue can cause high levels of pain and distress in patients with terminal cancer. Radiotherapy is used commonly to provide pain relief, however, the precise effectiveness of radiotherapy may be unclear. The objectives of this systematic review were to assess pain relief from localised bone metastases by radiotherapy, and from generalised metastases in other parts of the body by radiotherapy or radioisotopes. Several important findings were made. One patient in four will get complete pain relief after one month's radiotherapy treatment, while one patient in three will experience at least 50% relief after one month. Overall, radiotherapy produced at least 50% pain relief in a little less than half of patients at some other point during the study. Patients receiving radiotherapy plus strontium reported higher levels of well-being than those receiving radiotherapy plus placebo. Radioisotopes alone were found to produce a similar extent of relief to that provided by radiotherapy. The results confirm that both external irradiation and radioisotopes can provide effective pain relief for painful bone metastases. This is a significant finding given that analgesic drug regimes are often ineffective for this type of pain. Limitations of the review include poor reporting in the included studies about adverse effects of radiotherapy, e.g. vomiting and diarrhoea, and about the speed with which relief occurs or its duration.