Aims To examine the effect of radiotherapy for bone metastases on urinary markers of osteoclast activity. Materials and methods Patients with radiological evidence of bone metastases planned for palliative radiotherapy were eligible for the study. A urine specimen was collected before and 1 month after radiotherapy to assess levels of calcium, creatinine, magnesium, phosphate, N-telopeptide and pyridinoline. The Brief Pain Inventory was completed in person at baseline and by telephone follow-up at 1 month after radiotherapy. Patients were classified as responders (complete or partial pain response) or non-responders (stable or progressive pain) to radiotherapy based on the International Bone Metastases Consensus Criteria for end point measurements. Absolute values of urine markers were compared between responders and non-responders, or between responders and patients with progression. Results Our study population consisted of 74 men and 51 women. A single 8 Gy or 20 Gy in five daily fractions were commonly employed. At the 1 month follow-up, all Brief Pain Inventory functional interference scores showed a highly significant decrease from baseline (P<0.01). From our study population, 58 (64%) were classified as responders and 57 (46%) as non-responders to radiotherapy. We compared the urinary markers between the responders and the non-responders. There were no statistically significant differences between the two groups either in terms of baseline markers or in terms of month 1 follow-up markers. There was no significant change from baseline to the 1 month follow-up in responders or in non-responders to radiotherapy. Conclusion Baseline levels of urinary markers could not predict which patient would benefit from palliative radiotherapy.

Purpose/Objective(s)To determine the frequency of undertreatment of pain due to bone metastases using the pain management index (PMI) within dedicated palliative radiotherapy (RT) clinics in Canada, and to determine similarities and differences in trends.Materials/MethodsData was collected from the Odette Cancer Centre (OCC), Princess Margaret Hospital (PMH), and the Cross Cancer Institute (CCI). PMI was calculated by subtracting the pain score from the patient-rated Edmonton Symptom Assessment Scale or Brief Pain Inventory scale (0 = no pain, 1 = mild [1–4], 2 = moderate [5–6], 3 = severe [7–10]), from the analgesic score (0 = no pain medication, 1 = non-opioids, 2 = weak opioids, 3 = strong opioids). A negative PMI score reflected inadequate pain management and it was calculated based on prescribed analgesics for patients upon referral to the radiotherapy clinic.ResultsOf 2011 patients, the frequency of negative PMI was 31%, 17%, and 20% and was significantly different between centres (p<0.0001). The prevalence of patient-rated severe pain between centres was also significantly different (p<0.0001) at 55.5%, 43.4%, and 48.2%. However, there were no differences in the proportion of patients who rated their pain as moderate or mild (p = 0.345; p = 0.955). After adjusting for the cancer centre as a confounder, the prevalence of negative PMI correlated with higher KPS (p<0.0001) and older age (p = 0.0034), but not with gender (p = 0.1734) or primary cancer site (p = 0.4491). Severe pain was related to lower KPS (p<0.0001) and primary cancer site (p = 0.0283), but not to gender or age.ConclusionsA significant proportion of patients continue to present to palliative RT clinics with undertreated bony pain. There also appears to be geographic differences in analgesic use. A strategic plan of action to address the areas that require improvement is recommended. Purpose/Objective(s)To determine the frequency of undertreatment of pain due to bone metastases using the pain management index (PMI) within dedicated palliative radiotherapy (RT) clinics in Canada, and to determine similarities and differences in trends. To determine the frequency of undertreatment of pain due to bone metastases using the pain management index (PMI) within dedicated palliative radiotherapy (RT) clinics in Canada, and to determine similarities and differences in trends. Materials/MethodsData was collected from the Odette Cancer Centre (OCC), Princess Margaret Hospital (PMH), and the Cross Cancer Institute (CCI). PMI was calculated by subtracting the pain score from the patient-rated Edmonton Symptom Assessment Scale or Brief Pain Inventory scale (0 = no pain, 1 = mild [1–4], 2 = moderate [5–6], 3 = severe [7–10]), from the analgesic score (0 = no pain medication, 1 = non-opioids, 2 = weak opioids, 3 = strong opioids). A negative PMI score reflected inadequate pain management and it was calculated based on prescribed analgesics for patients upon referral to the radiotherapy clinic. Data was collected from the Odette Cancer Centre (OCC), Princess Margaret Hospital (PMH), and the Cross Cancer Institute (CCI). PMI was calculated by subtracting the pain score from the patient-rated Edmonton Symptom Assessment Scale or Brief Pain Inventory scale (0 = no pain, 1 = mild [1–4], 2 = moderate [5–6], 3 = severe [7–10]), from the analgesic score (0 = no pain medication, 1 = non-opioids, 2 = weak opioids, 3 = strong opioids). A negative PMI score reflected inadequate pain management and it was calculated based on prescribed analgesics for patients upon referral to the radiotherapy clinic. ResultsOf 2011 patients, the frequency of negative PMI was 31%, 17%, and 20% and was significantly different between centres (p<0.0001). The prevalence of patient-rated severe pain between centres was also significantly different (p<0.0001) at 55.5%, 43.4%, and 48.2%. However, there were no differences in the proportion of patients who rated their pain as moderate or mild (p = 0.345; p = 0.955). After adjusting for the cancer centre as a confounder, the prevalence of negative PMI correlated with higher KPS (p<0.0001) and older age (p = 0.0034), but not with gender (p = 0.1734) or primary cancer site (p = 0.4491). Severe pain was related to lower KPS (p<0.0001) and primary cancer site (p = 0.0283), but not to gender or age. Of 2011 patients, the frequency of negative PMI was 31%, 17%, and 20% and was significantly different between centres (p<0.0001). The prevalence of patient-rated severe pain between centres was also significantly different (p<0.0001) at 55.5%, 43.4%, and 48.2%. However, there were no differences in the proportion of patients who rated their pain as moderate or mild (p = 0.345; p = 0.955). After adjusting for the cancer centre as a confounder, the prevalence of negative PMI correlated with higher KPS (p<0.0001) and older age (p = 0.0034), but not with gender (p = 0.1734) or primary cancer site (p = 0.4491). Severe pain was related to lower KPS (p<0.0001) and primary cancer site (p = 0.0283), but not to gender or age. ConclusionsA significant proportion of patients continue to present to palliative RT clinics with undertreated bony pain. There also appears to be geographic differences in analgesic use. A strategic plan of action to address the areas that require improvement is recommended. A significant proportion of patients continue to present to palliative RT clinics with undertreated bony pain. There also appears to be geographic differences in analgesic use. A strategic plan of action to address the areas that require improvement is recommended.

Background: Canadian data describing inpatient palliative care unit (PCU) utilization are scarce. In the present study, we performed a quality assessment of a 24-bed short-term PCU with a 3-months-or-less life expectancy policy in a tertiary care setting. Methods: Using a retrospective chart review, we explored wait time (WT) for admission (May 2005 to April 2006), length of stay [LOS (February 2005 to January 2006)], and patient demographics. Results: The WT data showed 508 referrals, with 242 resulting in admissions (92% malignant diagnoses) and 266 not (82% malignant). The most common malignancies in both groups were gastrointestinal, lung, and genitourinary. Median WT for admitted patients was 6 days, varying with referral source, such as the same hospital, home, or another hospital (6, 4, and 8.5 days respectively). Most admissions (93%) occurred in 21 or fewer days. Patient death (52%), admission to another PCU (25%), and declined offer (10%) were common reasons for no admission. Median LOS for 219 admitted patients was 19 days (range: 0–249 days). Most patients (94%) died in the PCU; a minority were discharged. Conclusions: Many patients requiring PCU services are admitted within a few days of referral, especially patients with the least available support: those at home. However, half of the non-admitted patients die while waiting—a potential area for improvement. The LOS for admitted patients complied with the 3-month “expected lifespan” PCU policy. Results are significant, because ensuring quality of life for palliative care patients includes timely PCU access and sufficient LOS to address end-of-life needs.

Approximately 27% of North American cancer deaths are attributable to cancer of the lung. Many lung cancers are found at an advanced stage, rendering the tumours inoperable and the patients palliative. Common symptoms associated with palliative lung cancer include cough, hemoptysis, and dyspnea, all of which can significantly debilitate and diminish quality of life (qol). In studies of the effects of cancer therapies, the frequent evaluative endpoints are survival and local control; however, it is imperative that clinical trials with palliative patients also have a qol focus when a cure is unattainable. We conducted a literature review to investigate the use of qol instrument tools in trials studying qol or symptom palliation of primary lung cancer or lung metastases through the use of radiotherapy. We identified forty-three studies: nineteen used a qol tool, and twenty-four examined symptom palliation without the use of a qol instrument. The European Organization for Research and Treatment of Cancer (eortc) qlq-C30 survey was the most commonly used qol questionnaire (in thirteen of twenty trials). Of those thirteen studies, eight also incorporated the lung-specific qol survey eortc qlq-LC13 (or the eortc qlq-LC17). A second lung-specific survey, the Functional Assessment of Cancer Therapy–Lung (fact-L) was used in only two of the twenty trials. In total, only ten of forty-three trials (23%) used a lung-specific qol tool, suggesting that qol was of low priority as an endpoint and that measures created for lung cancer patients are underused. We encourage investigators in future trials to include specific qol instruments such as the eortc qlq-LC13 or the fact-L for studies in palliative thoracic radiotherapy because those instruments provide a measure of qol specific to patients with lung cancer or lung metastases.

PURPOSE:Radiotherapy for oncologic emergencies is an important aspect of the management of cancer patients. These emergencies-which include malignant spinal cord compression, brain metastases, superior vena cava obstruction, and uncontrolled tumour hemorrhage -may require treatment outside of hospital hours, particularly on weekends and hospital holidays. To date, there remains no consensus among radiation oncologists regarding the indications and appropriateness of radiotherapy treatment on weekends, and treatment decisions remain largely subjective. The main aim of the present study was to document the incidence and indications for patients receiving emergency treatment on weekends or scheduled hospital holidays at a single institution. The secondary aim was to investigate the compliance of such treatment with the institution's quality assurance policies, both local and provincial.METHODS:From September 1, 2002, to September 30, 2004, patients being treated over weekends (defined as commencing at 6 pm on a Friday and concluding at 8 am of the next scheduled workday) and hospital holidays were retrospectively identified using the Oncology Patient Information System scheduling module. Relevant patient data-including patient age, sex, primary cancer site, specific radiation field, rationale for treatment, referring hospital, total treatment dose, radiation dose fractionation, inpatient or outpatient status, and duration of treatment-were collected and subsequently analyzed. Comparison to local policy was performed subjectively.RESULTS:Over the 2-year period, 161 patients were prescribed urgent radiotherapy over a weekend or on a hospital holiday. Of this cohort, 68% were treated on both Saturday and Sunday, 22% on Saturday alone, and 10% on Sunday alone. Most patients presented with lung (31%), prostate (18%), and breast cancer (17%). The top reasons for referral for emergency weekend treatment included spinal cord compression (56%), brain metastases (15%), and superior vena cava obstruction (6%). Most of the indications for treatment generally followed the quality assurance policies implemented both locally and provincially.CONCLUSIONS:Patients treated over a weekend or on a hospital holiday were generally found to be treated with appropriate intent. Most treatment indications within this study both complied with provincial policy and showed a pattern of care similar to that seen in other studies in the literature. Local policy appears to be robust; however, policy improvements may allow for more cohesiveness across radiation oncologists in patterns of care in this important group of patients. Comparisons with practice at other institutions would be valuable and also a key step in developing sound guidelines for all members of the radiotherapy community to follow.

Brain metastasis is increasingly common, affecting 20%–40% of cancer patients. After diagnosis, survival is usually limited to months in these patients. Treatment for brain metastasis includes whole-brain radiation therapy, surgical resection, or both. These treatments aim to slow progression of disease and to improve or maintain neurologic function and quality of life. Although less common, primary brain tumours produce symptoms that are similar to those of brain metastasis. Glioblastoma, the most common malignant tumour of the brain, has a median survival of less than 12 months. Patients are often treated with surgical resection followed by radical radiation therapy and chemotherapy. Here, we present 2 separate cases of lesions in the brain radiologically compatible with brain metastasis. In both cases, no primary cancer site had been established, and neurosurgical intervention was sought to obtain a pathologic diagnosis. Both cases were pathologically confirmed as glioblastoma. These cases demonstrate the importance of differentiation between brain metastases and primary brain tumours to ensure that the appropriate management strategy is implemented.

Aims: Since 1999, randomised clinical trials and meta-analyses have reported equal efficacy of pain relief from single- and multiple-fraction radiotherapy for bone metastases. A number of factors, including limited radiotherapy resources, waiting times, and patient convenience, suggest single fraction to be the treatment of choice for patients. However, international patterns of practice indicate that multiple fractions are still commonly used. This study examined whether dose-fractionation schemes used for the treatment of bone metastases at the Rapid Response Radiotherapy Program (RRRP) at the Odette Cancer Centre have changed since 1999.Materials and methods: A retrospective review of the prospective RRRP database and hospital records were conducted for all patients treated with palliative radiotherapy for uncomplicated bone metastases at the RRRP in 1999 (or baseline), 2001, 2004 and from 1 January to 31 July 2005. Data were collected on patient demographics and clinical characteristics.Results: Of the 693 patients, 65 and 35% were prescribed single fraction (predominantly single 8 Gy) and multiple fractions (predominantly 20 Gy/five fractions), respectively. The administration of single treatments generally increased over time, from 51% in 1999 to 66% in 2005 (P = 0.0001). On the basis of multiple logistic regression analyses, patients were more likely to be prescribed single-fraction radiotherapy if they had prostate cancer, had a poorer performance status, were treated to the limbs, hips, shoulders, pelvis, ribs, scapula, sternum, or clavicle (compared with the spine), were treated by a radiation oncologist who had been trained in earlier years, and who were treated after 1999.Conclusions: Between 1999 and 2005, the use of single-fraction radiotherapy increased, corresponding to publications showing equal efficacy of pain relief between single and multiple fractions in the management of uncomplicated bone metastases. However, about a third of patients still received multiple fractions.

"Radiation recall"-also called "radiation recall dermatitis"-has been defined as the "recalling" by skin of previous radiation exposure in response to the administration of certain response-inducing drugs. Although the phenomenon is relatively well known in the medical world, an exact Cause has not been documented. Here, we report a rare occurrence of the radiation recall phenomenon in a breast cancer patient after palliative radiotherapy for bone, brain, and orbital metastases.

To explore the presence of symptom clusters in brain metastases patients treated with whole brain radiotherapy (WBRT). The Spitzer Quality of Life Index is a questionnaire composed of 5 quality of life (QOL) items and 17 symptoms. Utilizing a Principal Component Analysis (PCA), QOL items and symptoms were analyzed for the presence of symptom clusters. The Cronbach alpha statistic was used to estimate the internal consistency and reliability of the derived clusters. From August 2005 to October 2007, 129 patients completed the baseline Spitzer questionnaire. Ninety-two, 68, and 41 patients completed the questionnaire at the 4, 8, and 12-week telephone follow-up assessments, respectively. Symptom clusters consist of at least two or three interrelated symptoms that may have a synergistic effect on patient morbidity. Analysis of the 5 QOL items revealed two clusters. Cluster 1 consisted of activity, daily living and health. Cluster 2 consisted of support and outlook (Cronbach's alpha: 0.69 and 0.40, respectively). The two clusters accounted for 64% of the total variance. Analysis of the 17 symptom items revealed three clusters at baseline and 4 weeks, five clusters at 8 weeks, and four clusters at 12 weeks post-WBRT. These clusters changed slightly over time, but certain symptoms appeared to remain in one cluster: (1) trouble concentrating, confusion; (2) memory loss, decreased alertness; (3) nausea, vomiting; (4) numbness, weakness. Symptom cluster analysis has proved to be therapeutically important in the treatment of palliative cancer patients. Our study suggests that symptom clusters appear in brain metastases patients and change slightly over time. By treating a specific symptom, it may be possible to subsequently relieve inter-related symptoms, thereby improving daily functioning by decreasing symptom severity and improving overall QOL.

Our objective in this study was to review the experience of a one-stop multidisciplinary bone metastases clinic (BMC) that offers a coordinated multidisciplinary approach to the care of cancer patients with bone metastases in a tertiary cancer centre. Patients with symptomatic bone metastases were referred to BMC and assessed by a team of specialists in various disciplines - interventional radiology, orthopedic surgery, palliative medicine, and radiation oncology. At initial consultation, patient demographics, reasons for referral, and case disposition were recorded. From January 1999 to February 2005, a total of 272 patients with bone metastases were referred to the BMC. The median age was 65 years (range 28-95) and median KPS score at consultation was 60 (range 30-90). The majority of patients came from home (74%), while others came from a nursing home or the hospital (9%). Almost a third (28%) of patients had 2 or more reasons of referral, yielding a total of 354 reasons. The most common reason for referral was bone pain (42%), bone metastases (21%), high risk for pathological fracture (12%), and pathological fracture (10%). Of the 272 patients who received consultation, 40% received palliative radiotherapy, 19% received interventional surgery, 7% were referred to other support services such as palliative care, physiotherapy, and 7% had further investigation or imaging. A multidisciplinary clinic is useful for co-coordinating the management of bone metastatic disease in symptomatic patients.

Purpose/Objective(s)There has been limited report outlining the radiosensitivity of osseous metastases from gastrointestinal cancers. This study prospectively evaluated the response rates of symptomatic bone metastases from gastrointestinal cancers following palliative radiotherapy (RT).Materials/MethodsPatients with bone metastases from gastrointestinal cancers treated with palliative RT were eligible. Pain scores and analgesic consumption were recorded using the Brief Pain Inventory at baseline with follow up at 4, 8, and 12 weeks. Complete response rates (CR), partial response rates (PR) and overall response rates (CR+PR) were evaluated according to international consensus endpoints. CR was defined as a pain score of zero at the treated site with no concomitant increase in analgesic intake (stable or reducing analgesics in daily oral morphine equivalents). PR was defined as any of the following:–pain reduction of 2 or more at the treated site on a 0–10 scale without analgesic increase;–analgesic reduction of 25% or more from baseline without an increase in pain.ResultsFrom a database of 512 patients of all primary cancer sites, 69 patients with gastrointestinal primaries were identified. There were 48 males (70%) and 21 females (30%). Median age was 68 years (range 37–89). Of the 69 patients of gastrointestinal primaries, sites of origin included colorectal (68%), pancreatic (16%), gastric (9%), esophageal (4%), and liver (3%). The most common sites of RT were the skull/thoracic spine (41%), the extremities (35%), and the pelvis (19%). A total of 34 patents (49%) received a single 8 Gy, 30 patients (44%) received 20 Gy in five fractions, and the remaining 5 patients (7%) had other radiation fractionations. Assessment of the 69 patients with metastatic gastrointestinal cancers revealed CR, PR, and CR+PR rates of 18%, 42%, and 61% at 4 weeks, 22%, 35%, and 57% at 8 weeks and 50%, 21%, and 71% at 12 weeks, respectively, for evaluable patients. Comparison was made to the response rates at 4, 8 and 12 weeks against the 512 patients of all metastatic primary cancer sites. For the complete group of patients, CR, PR, and CR+PR were 24%, 26%, and 50% at 4 weeks, 25%, 22%, and 47% at 8 weeks, and 23%, 28%, and 51% at 12 weeks, respectively, for evaluable patients. There were no statistically significant differences.ConclusionsAlthough published data is limited, a literature review revealed RT is effective in controlling pain from osseous metastases of gastrointestinal origin. A comparison was made of RT response rates in 69 metastatic patients with gastrointestinal primary cancer with all primary cancer sites using previously compiled data of 512 patients. No significant difference in response to RT was found. Bone metastases from gastrointestinal cancers are equally radiosensitive. Purpose/Objective(s)There has been limited report outlining the radiosensitivity of osseous metastases from gastrointestinal cancers. This study prospectively evaluated the response rates of symptomatic bone metastases from gastrointestinal cancers following palliative radiotherapy (RT). There has been limited report outlining the radiosensitivity of osseous metastases from gastrointestinal cancers. This study prospectively evaluated the response rates of symptomatic bone metastases from gastrointestinal cancers following palliative radiotherapy (RT). Materials/MethodsPatients with bone metastases from gastrointestinal cancers treated with palliative RT were eligible. Pain scores and analgesic consumption were recorded using the Brief Pain Inventory at baseline with follow up at 4, 8, and 12 weeks. Complete response rates (CR), partial response rates (PR) and overall response rates (CR+PR) were evaluated according to international consensus endpoints. CR was defined as a pain score of zero at the treated site with no concomitant increase in analgesic intake (stable or reducing analgesics in daily oral morphine equivalents). PR was defined as any of the following:–pain reduction of 2 or more at the treated site on a 0–10 scale without analgesic increase;–analgesic reduction of 25% or more from baseline without an increase in pain. Patients with bone metastases from gastrointestinal cancers treated with palliative RT were eligible. Pain scores and analgesic consumption were recorded using the Brief Pain Inventory at baseline with follow up at 4, 8, and 12 weeks. Complete response rates (CR), partial response rates (PR) and overall response rates (CR+PR) were evaluated according to international consensus endpoints. CR was defined as a pain score of zero at the treated site with no concomitant increase in analgesic intake (stable or reducing analgesics in daily oral morphine equivalents). PR was defined as any of the following:–pain reduction of 2 or more at the treated site on a 0–10 scale without analgesic increase;–analgesic reduction of 25% or more from baseline without an increase in pain. ResultsFrom a database of 512 patients of all primary cancer sites, 69 patients with gastrointestinal primaries were identified. There were 48 males (70%) and 21 females (30%). Median age was 68 years (range 37–89). Of the 69 patients of gastrointestinal primaries, sites of origin included colorectal (68%), pancreatic (16%), gastric (9%), esophageal (4%), and liver (3%). The most common sites of RT were the skull/thoracic spine (41%), the extremities (35%), and the pelvis (19%). A total of 34 patents (49%) received a single 8 Gy, 30 patients (44%) received 20 Gy in five fractions, and the remaining 5 patients (7%) had other radiation fractionations. Assessment of the 69 patients with metastatic gastrointestinal cancers revealed CR, PR, and CR+PR rates of 18%, 42%, and 61% at 4 weeks, 22%, 35%, and 57% at 8 weeks and 50%, 21%, and 71% at 12 weeks, respectively, for evaluable patients. Comparison was made to the response rates at 4, 8 and 12 weeks against the 512 patients of all metastatic primary cancer sites. For the complete group of patients, CR, PR, and CR+PR were 24%, 26%, and 50% at 4 weeks, 25%, 22%, and 47% at 8 weeks, and 23%, 28%, and 51% at 12 weeks, respectively, for evaluable patients. There were no statistically significant differences. From a database of 512 patients of all primary cancer sites, 69 patients with gastrointestinal primaries were identified. There were 48 males (70%) and 21 females (30%). Median age was 68 years (range 37–89). Of the 69 patients of gastrointestinal primaries, sites of origin included colorectal (68%), pancreatic (16%), gastric (9%), esophageal (4%), and liver (3%). The most common sites of RT were the skull/thoracic spine (41%), the extremities (35%), and the pelvis (19%). A total of 34 patents (49%) received a single 8 Gy, 30 patients (44%) received 20 Gy in five fractions, and the remaining 5 patients (7%) had other radiation fractionations. Assessment of the 69 patients with metastatic gastrointestinal cancers revealed CR, PR, and CR+PR rates of 18%, 42%, and 61% at 4 weeks, 22%, 35%, and 57% at 8 weeks and 50%, 21%, and 71% at 12 weeks, respectively, for evaluable patients. Comparison was made to the response rates at 4, 8 and 12 weeks against the 512 patients of all metastatic primary cancer sites. For the complete group of patients, CR, PR, and CR+PR were 24%, 26%, and 50% at 4 weeks, 25%, 22%, and 47% at 8 weeks, and 23%, 28%, and 51% at 12 weeks, respectively, for evaluable patients. There were no statistically significant differences. ConclusionsAlthough published data is limited, a literature review revealed RT is effective in controlling pain from osseous metastases of gastrointestinal origin. A comparison was made of RT response rates in 69 metastatic patients with gastrointestinal primary cancer with all primary cancer sites using previously compiled data of 512 patients. No significant difference in response to RT was found. Bone metastases from gastrointestinal cancers are equally radiosensitive. Although published data is limited, a literature review revealed RT is effective in controlling pain from osseous metastases of gastrointestinal origin. A comparison was made of RT response rates in 69 metastatic patients with gastrointestinal primary cancer with all primary cancer sites using previously compiled data of 512 patients. No significant difference in response to RT was found. Bone metastases from gastrointestinal cancers are equally radiosensitive.

Minimally invasive procedures such as percutaneous cementoplasty can provide immediate pain relief and can restore mechanical stability for patients with bone metastases who are not candidates for surgery or who show resistance to radiotherapy or analgesic treatment. Here, we examine a case of percutaneous cementoplasty to treat a lytic lesion of the acetabulum from breast cancer. Good filling was observed, and no complications occurred. A research assistant recorded the patient’s scores on the Karnofsky Performance Scale, Townsend Functional Assessment Scale, and Brief Pain Inventory before surgery and at days 1, 2, and 4 and weeks 1, 2, and 4 post-procedure. Improvement in pain and walking ability was demonstrated within the first 48 hours of treatment, and that improvement remained constant throughout follow-up. These findings echo the literature, in that percutaneous cementoplasty provides immediate and long-term pain relief with few complications. We recommend that percutaneous cementoplasty be used as an additional tool for palliative treatment of patients with bone metastases.

Prostate cancer is the most common non-skin malignancy in men. Almost all men who die from prostate cancer have hormone-refractory prostate cancer with metastasis to bone. Emerging supportive treatments—including chemotherapy, bisphosphonates, and surgery—require integration that is optimized in a multidisciplinary setting. A multidisciplinary clinic for bone metastases has been in place at Toronto–Sunnybrook Regional Cancer Centre since 1999, combining orthopedic surgery, radiation oncology, interventional radiology, and palliative medicine for all patients with bone metastases. The addition of a prostate-focused multidisciplinary clinic integrates these services for patients with advanced prostate cancer.

Background: Wait times for radiation therapy (RT) in Ontario have been a problem for many years. In 1996 the TSRCC initiated a Rapid Response Radiotherapy Program (RRRP) to provide timely palliative RT for symptom relief of terminal cancer. A review of the first 8 years of service concluded that the clinic was a success.

Background: Waiting for radiation therapy (RT) in Ontario has been a major problem for the past decade. In 1996, the Toronto-Sunnybrook Regional Cancer Centre (TSRCC) initiated a Rapid Response Radiotherapy Program (RRRP) to provide timely palliative RT for symptom relief of patients with terminal cancer. Purpose: This study reviews the clinical activity of the RRRP over the past 8 years to evaluate if we are meeting the objectives of the program. Materials and methods: From the TSRCC oncology patient information system (OPIS) database, we retrieved the number of patients referred to the RRRP, their demographics, diagnosis and treatment for the calendar years 1996 to 2003 inclusive. We calculated the time interval between referral to consultation, consultation to simulation and the percentage of cases who started RT on their initial consultation for all new cases referred to the RRRP. Results: From 1996 to 2003, the number of cases seen in consultation increased from just over 200 cases annually in the first 2 years to about 500 cases per year in the last 4 years, for a total of 3,290. There were 1,792 (54%) men and 1,498 (46%) women; median age was 69 years (range, 21-95 years). Breast, lung, genitourinary and gastrointestinal primaries accounted for over 80% of all referrals. The majority was referred for palliative treatment of symptomatic bone (70%) or brain (14%) metastases. The dose fractionation for bone metastases was a single 8-Gy fraction in 45%, 20 Gy in five fractions in 42%, 30 Gy in ten fractions in 4% and other dose fractionations in 9%. Nearly 90% were seen within 2 weeks of referral (38% within 1 week). Eighty-five percent were simulated on the day of their initial consultation. Sixty percent started their RT treatment on the day of their consultation visit. The overall median interval from referral to treatment was 8 days. Conclusion: Over the past 8 years, the annual number of new cases referred to the RRRP has doubled. The overall median interval from referral to consultation was 8 days. Sixty percent were simulated, planned and started treatment on the day of their initial consultation. We therefore are meeting our goal of providing rapid access to palliative RT for symptomatic cancer patients.

Post-mastectomy radiotherapy has been demonstrated to improve locoregional control in breast cancer patients. We report a case involving a 44-year-old breast cancer patient who presented with a solitary bone metastasis in the area beneath the shoulder shield, likely from a coincidental recurrence.