Treating Bone Metastases

Treatments can often shrink or slow the growth of bone metastases and can help with any symptoms they cause. But they usually do not make the metastases go away completely. Some people believe that nothing more can be done if the cancer can’t be cured, so they stop all treatment. But radiation, chemotherapy (and other drugs), surgery, and other treatments can often slow cancer growth and help control symptoms. And relieving symptoms like pain and constipation can help you feel better. Something can almost always be done to help maintain or improve your quality of life.

At any stage of cancer, the goal of treatment should be clear. You should know if the goal is to cure the cancer, slow its growth and help you live longer, or relieve symptoms. This can sometimes be confusing because some treatments used to cure cancer are also used to slow its growth or relieve symptoms.

Treatment options for people with bone metastases depend on many things:

  • What kind of primary cancer you have
  • Which bones (and how many) the cancer has spread to
  • Whether any bones have been weakened or broken
  • Which treatments you have already had
  • Your symptoms
  • Your general state of health

Systemic treatments (which go through the whole body) and local treatments (which treat only the cancer in the bone) are the 2 main types of treatment for bone metastases. Depending on the extent and location of the metastases, one or both of these types of treatment may be used.

Systemic treatments for bone metastases

Systemic treatments affect the whole body. In many cases, especially if the cancer has spread to many bones, systemic treatments are used because they can reach cancer cells all through the body.

Systemic therapies include chemotherapy, hormone therapy, or other medicines that are taken by mouth or injected into the blood. These treatments are not aimed specifically at bone metastases, but they often help treat them.

Other systemic treatments, such as radiopharmaceuticals and bisphosphonates (see sections below), are aimed more specifically at cancer that has reached the bones. Sometimes both of these types of treatments are used at the same time.

Chemotherapy

Chemotherapy (chemo) uses drugs that are injected into a vein or taken by mouth to kill cancer cells. These drugs enter the bloodstream and go throughout the body. Chemo is used as the main treatment for many types of metastatic cancer. It can often help shrink tumors, which can reduce pain and help you feel better, but it doesn’t make them go away and stay away. It’s sometimes used with local treatments such as radiation.

Visit the Chemotherapy section to learn more about chemo and dealing with side effects, or contact us (1-800-227-2345).

Hormone therapy

Hormone therapy drugs block the actions of certain hormones or reduce how much is made. This therapy is most often used to treat breast and prostate cancer, and it can be used when these cancers spread to the bone as well.

For instance, estrogen is a hormone that causes many breast cancers to grow. Drugs can lower estrogen levels or block the effect that estrogen has on breast cancer cells. When breast cancer has spread to the bones, this may stop cell growth and even cause tumors to shrink.

Likewise, male sex hormones, called androgens, make most prostate cancers grow. Drugs that lower androgen levels or block their effect can help stop or slow growth of these cancers.

Targeted therapy

Targeted therapy drugs attack specific parts of cancer cells or other cells or proteins that help cancer cells grow. These drugs work differently from standard chemo drugs. They can be used alone or along with other treatments to treat bone metastases.

To see what targeted drugs can be used to treat your cancer, see information about that specific type of cancer.

Immunotherapy

Immunotherapy is a systemic therapy that boosts the body’s immune system or uses man-made versions of immune system proteins to kill cancer cells. Immunotherapy may be used to treat bone metastases.

To see if immunotherapy is used to treat the cancer you have, see information about that type of cancer.

Radiopharmaceuticals

Radiopharmaceuticals are a group of drugs that carry radioactive elements. These drugs are injected into a vein and settle in areas of bone with active turnover (like those containing cancer spread). Once there, the radiation they give off kills cancer cells.

If cancer has spread to many bones, radiopharmaceuticals work better than trying to aim external beam radiation at each affected bone. (External beam radiation is discussed below as a local treatment.) In some cases, radiopharmaceuticals may be used along with external beam radiation that’s aimed at the most painful bone metastases.

Some of the radiopharmaceuticals approved for use in the United States include:

  • Strontium-89 (Metastron®)
  • Samarium-153 (Quadramet®)
  • Radium-223 (Xofigo®)

Treatment with a radiopharmaceutical can often reduce pain from bone metastases for several months. Re-treatment is possible when the pain returns, but the pain might not be reduced for as long as it was with the first treatment.

These drugs work best when the metastases are blastic, meaning the cancer has stimulated certain bone cells (osteoblasts) to form new areas of bone.

See Radiation Therapy to learn more about this type of treatment.

Other drugs for bone metastases

Bisphosphonates

Bisphosphonates are a group of drugs that may be used to treat cancer that has spread to the bones. These drugs work by slowing down the action of osteoclasts. These bone cells normally dissolve small bits of bones to help remodel them and keep them strong. But osteoclasts are often overactive when cancer spreads to the bones, which can cause problems.

Bisphosphonates can help with cancer that has spread to the bones by:

  • Reducing bone pain
  • Slowing down bone damage caused by the cancer
  • Reducing high blood calcium levels (hypercalcemia)
  • Lowering the risk of broken bones

Bisphosphonates tend to work better when x-rays show the metastatic cancer is thinning and weakening the bone (lytic metastases). They don’t work as well for treating blastic metastases, where the bones become denser.

The most common side effects of bisphosphonates are fatigue, fever, nausea, vomiting, anemia (a low red blood cell count), and bone or joint pain. But other drugs or the cancer itself can cause many of these effects, too. These drugs can lower calcium levels, so they can’t be given to someone whose calcium levels are already low. Bisphosphonates can cause kidney damage and often can’t be given to people with poor kidney function.

Medication-related osteonecrosis of the jaw

A rare but very serious side effect of bisphosphonates is osteonecrosis (OS-tee-o-nuh-CROW-sis) of the jaw or ONJ. In ONJ, part of the jaw bone loses its blood supply and dies. This can lead to tooth loss and infections or open sores of the jaw bone that won’t heal and are hard to treat.

ONJ is very hard to treat and prevention is very important. ONJ sometimes seems to be triggered by having a tooth pulled while taking bisphosphonates. Many cancer doctors advise patients to get a dental check-up and have any tooth or jaw problems treated before they start taking a bisphosphonate. Maintaining good oral hygiene by flossing and brushing, making sure that dentures fit properly, and having regular dental check-ups might also help prevent ONJ.

Denosumab

Denosumab is another drug that can help when cancer spreads to bone. Like the bisphosphonates, this drug keeps osteoclasts from being turned on, but it does so in a different way, by blocking a substance called RANKL.

Common side effects include nausea, diarrhea, and feeling weak or tired. Like the bisphosphonates, denosumab can cause osteonecrosis of the jaw (ONJ), so doctors recommend taking the same precautions (such as having tooth and jaw problems treated before starting the drug). Unlike the bisphosphonates, this drug is safe to give to patients with kidney problems.

Local treatments for bone metastases

Local treatments, including radiation therapy, surgery and other techniques, are directed at one part instead of the entire body.

Local treatments can be useful if the cancer has spread to only one bone, or if there are areas of cancer spread that are worse than others and need to be treated right away. These treatments can help relieve pain or other symptoms caused by one or a few bone metastases.

Sometimes, local treatments such as surgery are used to stabilize a bone that’s in danger of breaking because it’s been weakened by cancer. It’s much easier to keep a damaged bone from breaking than to try and fix it after it has broken.

External radiation therapy

Radiation therapy uses high-energy rays or particles to destroy cancer cells or slow their growth. When a cancer has spread to a small number of spots in bones, radiation can be used to help relieve symptoms such as pain. If the bone is treated with radiation before it gets too weak, it may also help prevent a later fracture.

The most common way to give radiation for bone metastasis is to focus a beam of radiation from a machine outside the body. This is called external beam radiation.

Radiation therapy for bone metastasis can be given as 1 or 2 large doses or in smaller amounts over 5 to 10 treatments that result in a somewhat larger total dose. Both schedules give the same degree of pain relief. The major advantage of the 1- or 2-dose treatment is that fewer trips are needed for treatment. The advantage of more treatments is that patients are less likely to need re-treatment because of the pain coming back.

See our Radiation Therapy section to learn more about different kinds of external beam radiation, what it’s like to get radiation, and treatment side effects.

Ablation techniques

Putting a needle or probe right into a tumor and using heat, cold, or a chemical to destroy it is called ablation. It may be used if only 1 or 2 bone tumors are causing problems.

Radiofrequency ablation (RFA) is a common type. It uses a needle that carries an electric current. The tip of the needle is put into the bone tumor. CT scans may be used to be sure the needle is in the right place. An electric current is then sent through the needle to heats the tumor to destroy it. RFA is usually done while the patient is under general anesthesia (deeply asleep and not able to feel pain).

In another type of ablation, called cryoablation, a very cold probe is put into the tumor to freeze it, killing the cancer cells. Other methods use alcohol to kill the cells or other ways to heat the tumor (such as laser-induced interstitial thermotherapy). After the cancer tissue is destroyed, the space left behind may be filled with bone cement. (See below.)

Bone cement

Another option to strengthen and/or stabilize a bone is to use injections of quick-setting bone cement or glue called PMMA.

When PMMA is injected into a spinal bone it’s called vertebroplasty or kyphoplasty. This helps stabilize the bone and relieves pain in most people. Vertebroplasty often reduces pain right away and can be done in an outpatient setting.

When the bone cement is injected to strengthen bones other than the spine, it’s called cementoplasty. Sometimes, it’s used along with surgery, radiation, radiofrequency ablation, or other treatments.

Surgery

Surgery used to treat a bone metastasis is done to relieve symptoms and/or stabilize the bone to prevent fractures (breaks).

Bone metastases can weaken bones, leading to fractures that tend to heal very poorly. Surgery can be done to put in screws, rods, pins, plates, cages, or other devices to make the bone more stable and help prevent fractures. If the bone is already broken, surgery can often relieve pain quickly and help the patient return to their usual activities.

Sometimes a person can’t have surgery because of poor general health, other complications of the cancer, or side effects of other treatments. If doctors can’t surgically reinforce a bone that has metastasis, a cast or splint may help stabilize it to reduce pain so the person can move around.

Clinical trials

Clinical trials are carefully controlled research studies that are done with patients who volunteer for them. If you would like to take part in a clinical trial, you should start by asking your doctor if your clinic or hospital conducts clinical trials. You can also call our clinical trials matching service for a list of clinical trials that meet your medical needs. You can reach this service at 1-800-303-5691.

Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the only way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.

For more information, see Clinical Trials.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: December 16, 2016 Last Revised: December 16, 2016

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