• In Metastatic Disease Radiation is often used in treating metastatic disease, both to shrink tumors and to
relieve local symptoms such as pressure or pain. If metastatic bone lesions occur in a weight-bearing bone such
as the leg, for example, the bone may fracture with very little injury. This is called a pathologic fracture. Such
areas are usually given radiation to help heal the bone, decrease pain and control local spread of the tumor.
If a bone lesion is extensive, there may be a significant risk of pathologic fracture during the next several
months it might take to complete radiation therapy and healing. An orthopedic surgeon is often called in to
determine if a fixation device—such as a rod or plate surgically placed over the cancerous bone to stabilize it
should be used to minimize the risk of fracture during this time.
Similarly, pain in the spine or spinal lesions seen on a bone scan or x-ray should be promptly investigated. If
a metastatic tumor is present, there may be a risk of compression fractures of the vertebrae (even on simple
walking) or of pressure on the spinal cord by the tumor, which can result in paralysis. Tumors that spread to
the neck are especially worrisome because compression and fractures there can lead to paralysis of both arms
and legs (quadriplegia) as well as loss of bladder and bowel control (incontinence).
Pain is often produced by tumors pressing on nerves, and radiation may help relieve the pain by shrinking
these tumors. As is true in other types of cancer, the radiation dosage has to be kept low in some locations
because of the limited tolerance of normal tissues.
Side effects of radiotherapy may include tiredness and skin changes, but with modern techniques major complications are infrequent ( see Radiation Therapy and Treatment Side Effects ).
