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01.Vertebral Compression Fractures from Spinal Metastases: Imaging and Application of Kyphoplasty and Vertebroplasty (p. 63-71)
02.Bone Metastases and Quality of Life (p. 117-131)
03.Defining Oncologic Spinal Instability (p. 55-61)
04.Bisphosphonates in the Management of Bone Metastases (p. 91-97)
05.Evaluation of Photodynamic Therapy as Treatment for Spinal Metastases (p. 83-91)
06.Less Invasive Surgical Approaches for Spine Metastases (p. 73-81)
07.Management of Malignant Spinal Cord Compression (p. 43-53)
08.Palliative Radiotherapy of Bone Metastases and Pain Flare (p. 105-115)
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Conventional Radiation Treatment and Bone Metastases (p. 23-32) $45.00
Authors:  Shaelyn Culleton, Sheldon Kwok and Edward Chow
With approximately half of all advanced cancer patients developing bone metastases during the course of their disease, palliative radiation has become an important first line treatment in managing painful bony lesions. The most common palliative regimens used in treating painful bone metastases consist of 8Gy in a single fraction (frx), 20Gy in 5 frx and 30Gy in 10 frx. The optimal regimen (single versus multiple frxs) has been subject to much debate over the years. Earlier studies and meta-analyses published in the 80s and 90s provided mixed results without a clear consensus to support either fractionation scheme. One confounding factor in these analyses lay in inconsistent endpoint definitions for pain, and it became apparent that a consensus on endpoint definitions was a necessity. This resulted in a series of studies evaluating international patterns of practice, correlation of various pain scales, determining what meaningful change in pain response is for patients and the response shift phenomenon. It appears that despite evidence supporting equal efficacy of fractionation schemes using standardized endpoints, that the use of multiple fractionation schemes is still the most common dose-fractionation prescription for uncomplicated bone metastases. 

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Conventional Radiation Treatment and Bone Metastases (p. 23-32)