Types of Treatment for Bone Metastasis
How doctors treat bone metastasis depends on the extent and location of the bony lesions, Fasano says. Treatments include:
- Treating the underlying cancer. This is the most important step, Fasano tells WebMD. Treatment depends on the type of tumor and where it started in your body. Treatment often includes a combination of drugs that were used to treat the primary cancer when you were first diagnosed.
- Bisphosphonates. Bisphosphonate drugs such as Aredia and Zometa help prevent the breakdown of bone, which can ease pain and reduce your risk of fractures. Doctors will infuse bisphosphonates through an IV "every four weeks to halt or slow the progression of metastasis formation and to help prevent breaks," says Fasano.
Bisphosphonate therapy is especially important if the metastasis is in a weight-bearing bone or is causing a great deal of pain. If metastasis in the spine is causing severe pain and risking a collapse of vertebrae, Fasano sends the patient for an orthopedic evaluation. For elevated calcium levels, patients will often need intravenous fluids, bisphosphonates, and other medications to help lower levels.
- Denosumab (Xgeva). Denosumab is injected under the skin, rather than by infusion, and also helps prevent bone breakdown. It's more expensive than bisphosphonates, so some insurance companies will pay for it only after you've first tried a bisphosphonate.
- Vertebroplasty. In this outpatient procedure, bone cement is injected into a fractured vertebra. The cement hardens quickly and can dramatically improve back pain within hours. "This is not a major surgery and it can make a big difference," Fasano says.
- Surgery and/or radiation. If a fracture seems likely in the near future, an orthopaedic surgeon may insert a rod or pin to stabilize the bone. "Typically, we also do a couple of radiation sessions to further stabilize the bone," Fasano says. Radiation aims high-energy X-rays at the tumor to kill the cancer. If surgery isn't needed, radiation therapy alone may ease pain. "Depending upon the location and extent of the tumors, this usually involves five to 10 sessions," she says.
Treatment for bone metastasis can prolong life and relieve symptoms. Much depends upon the type of cancer you have, how old you are, and how much time has elapsed since you first were diagnosed. "But many people can do really well for a long period of time," Fasano says.