Complications
- Osteonecrosis
- Pathologic fx/dislocation
- Insufficiency fx
- Reported in the pelvis after XRT for carcinoma of the cervix, endometrial carcinoma
- Post-irradiation symphysitis leading to pubic diastasis reported
- Late sarcoma
Soft tissue complications
- Wound healing problems
Unresponsive tumors
- Renal cell carcinoma
Palliates symptoms (immediately or gradually in ? 50%)
- May stop or shrink tumor locally
- As effective with spinal cord or nerve root compression except when bony instability
- May inhibit release of chemical mediators
- May stop bone destruction (and pathologic fx development)
- Repair is slowed (or stopped above 50 Gy)
- Maximal bone healing by 3 months
- May not alleviate symptoms (up to 35%)
- Dosage: 25-50 Gy pre- or post-operatively (usually 30 Gy)
- 8 Gy in a single dose reported with satisfactory palliation and suggested to be appropriate for pts with poor performance status
- Pain relief 92% with 40-46 Gy in 20-23 fractions, 80% with 30-36 Gy in 10-122 fractions, and 62% with 8-28 gy in 1-4 fractions
- Bone-seeking radionucleotides to treat bone pain (may initially exacerbate pain)
- I131: thyroid cancer
-
- Pulmonary lesions: 70% complete response, 30% partial response
-
- Bony lesions: 20-30% partial response
-
- Yttrium90
-
- P32 (hematological toxicity)
-
- Sr89 (reversable thrombocytopenia): breast and prostate
-
- Complexed with bisphosphonates under investigation
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