Studies on the treatment of bone metastases

Due to earlier detection and improved treatment, cancer patients’ life expectancy has improved. Patients with cancer are living longer, which means they are longer at risk of developing bone metastases. Bone metastases have a high impact on the patient’s life as they often cause pain, reduced mobility due to pathological fractures and/or hypercalcemia which can cause (among others) cardiac arrythmias, renal failure and pancreatitis. If bone metastases are present in the spine, they can cause spinal instability, compression of the spinal cord. Treatment of bone metastases is considered to be palliative care, aiming to improve or preserve quality of life. Treatment consists of pain medication and/or radiotherapy. If there is an (impending) fracture, surgery could be necessary. In this thesis, we demonstrated that body morphology could be used to improve the estimation of life expectancy in the patients treated with radiotherapy for spinal metastases and patients who underwent surgery for the spinal metastases. Furthermore, effectiveness of stereotactic body radiation therapy (SBRT) and conventional radiotherapy (cRT) were compared in patients with painful bone metastases. After treatment with SBRT or cRT, a comparable pain response and comparable improvement of quality-of-life(QoL) scores was observed. Furthermore, we found that the Trials within Cohorts (TwiCs) design was a feasible design to include patients in the palliative setting and gave an insight in patients’ acceptability of an innovative intervention. Lastly, we found that bone mineral density of the vertebra increased after radiotherapy for spinal