**New Paradigms of Radiotherapy for Bone Metastasis**

Yasuo Ejima, Takeaki Ishihara, Daisuke Miyawaki, Kenichiro Kakutani, Kotaro Nishida, Junichiro Inoue, Yoshitada Sakai, Tianyuan Wang and Ryohei Sasaki

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/66939

#### Abstract

Proper care of patients with bone metastasis requires interdisciplinary treatments. Radiotherapy (RT) plays a central role in the management of painful bone metastasis. External beam RT can provide rapid successful palliation of painful bone metastasis in 50–80% of patients, is associated with very few adverse effects and leads to complete pain relief at the treated site in up to one-third of patients. Intensity-modulated RT (IMRT) or stereotactic body RT (SBRT) enables the delivery of higher doses to the target tumor while minimizing the dose to adjacent organs. Reirradiation using IMRT or SBRT is a valuable option for the management of bone metastases. A multidisciplinary team, especially one consisting of a spinal surgeon and rehabilitation physician, is particularly useful for treating patients with spinal bone metastases characterized by spinal instability. Rehabilitation intervention which increases the physical activity level and prevents deconditioning is important. Future developments in surgical procedures and RT will likely improve the management protocols for bone metastases and technology to reduce metal artifacts in radiation planning might improve the efficacy and safety of combination therapy.

Keywords: spinal metastases, intensity-modulated radiotherapy, rehabilitation, multidisciplinary team, stereotactic body radiotherapy
