Radiate non-active bone lesion? Benefits?

42young,

My situation is not exactly like yours but my story may help. I was dx'ed with a bone met within 6 weeks of my bmx which was stage IIB. As this was over 8 1/2 years ago, drugs like Ibrance and Verzenio were still in trials. I had no pain nor any other symptoms with my bone met. I started on an AI and had rads x15 to the bone met with the intent to kill the little bugger. If your mets are not metabolically active, what would you hope to achieve with rads? My met is still visible on scans butit is necrotic. I have had no progression since rads. Wishing you the best.

42young,

That’s a good question and in my professional opinion, as an elementary school teacher... I have no idea! I apologize if my sense of humor is not appropriate when talking mbc but I’m a big believer in humor. I know some mo’s only do rads to bone mets to alleviate pain. My mo sent me to the ro, despite the fact that I had no pain. The ro looked at my scan and announced that he wanted to do rads to “kill the little bugger” . My ro was a hoot! Anyway, 15 treatments and almost 9 years after the fact and I have had no progression. I certainly think it’s worth discussing with your mo. BTW, my bone met was on my upper femur. Take care.

Thanks again exbrnxgrl.

Cyathea, thanks for sharing. I will discuss with my RO about it. Good luck with your radiation!!

42young, I don't think radiating an inactive met would give any benefit but I am no scientist. It may be better to reserve that until a bone met is causing an issue. Bone mets are a bit trickier than other mets because some will never fully disappear on scans. They leave scar-type areas. To further complicate matters, the healed bone mets look similar to active "blastic" bone mets as both are described as "sclerotic". The only way to tell the difference would typically be the level of activity in the met and not the appearance. Most people have a mix of lytic (causing holes/weakness in the bone) and blastic bone mets (causing excess deposit of bone), but they are usually predominantly lytic. Whereas a liver met could either be inactive or the tumor could disappear, I don't think bone mets work in the same way. I was diagnosed over 5 years ago in very bad shape and in excruciating pain. My bones were swiss cheese pretty much everywhere and throwing off calcium into my blood causing a dangerous, uncontrollable hypercalcemia. However, after starting systemic treatment, they became inactive immediately, healed over about 6 months to a year's time and have remained that way ever since with one small exception. Last year, I spent a long period off treatment waiting to start a trial and then took a trial medication that did not ever start to work whatsoever. At the time I stopped that trial med, I had one bone met in my spine light up. I never had any other issues before or after that. My point is you may never need radiation. I never had it as it was never recommended to me. Radiation can impact the quality of the bone and make it more brittle. Thus, it is a question in each case of whether the benefits outweigh the risks. If there is no pressing issue - such as extreme pain or risk of vertabrae collapse or bone fracture, it is probably not worth doing radiation at this point. Also, there is a limited amount of rads one can have to the same bone area in a lifetime. For that reason, it may be better to save rads as well.

Would be worth going to a major cancer center for a second opinion. My spinal lesion has been inactive for 12 years after 25 zaps concurrently with axilla, chest wall and supraclavicular areas. It can no longer be detected on scans. I had two opinions then with the same recommendation. I was NED from chemo and still received radiation therapy. Things may have changed since and recommendations vary from individual to individual in any case.

42- MD Anderson went thru their records awhile back and found they could flat-out cure 25% of oligometastatic patients by aggressive treatment on the few lesions they had (usually radiation to bone, which is needed to kill that cancer). so yeah its radiation, but you might get lucky or at least reatly delay recurrence