Edward Chow & Ronald Chow 
Cancer 
Bone Metastases, CNS Metastases and Pathological Fractures

Breanne Lechner, MD(C) is a clinical research assistant in the Rapid Response Radiotherapy Program at the Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada and also a medical student at the University of Toronto. She was the recipient of the J Frank Brookfield Scholarship from the University of Waterloo in 2012 for excellence in biology.With effective systemic therapy and comprehensive supportive care, patients with metastases can live longer. Breast cancer patients with only or predominantly bone metastases have a median survival of 2.3 years following diagnosis, while metastatic prostate cancer patients have a median survival time of 11.3 months. With recent advances in research, the overall survivorship of metastatic patients has increased. The improved quality of care for metastatic cancer patients has resulted in longer survivorship. Living longer can lead to a higher chance of development for skeletal-related events (SREs), which are defined as either spinal cord compression, hypercalcemia, pathological fractures or a need for palliative radiation therapy or surgery for bone pain. To try to reduce pathological fractures, it is important to detect impending fractures earlier and to administer prophylactic surgery as needed. Longer survivorship also allows time for the development of brain metastases. Recent advances incorporating stereotactic radiosurgery (SRS) have been favored over conventional whole-brain radiation therapy (WBRT) in the preservation of neurocognitive functions and survival benefit in patients less than 50 years of age. Multidisciplinary clinics for brain metastases are again desirable with the joint input of the radiation oncologists and neurosurgeons.