Palliation of bone metastases—exploring options beyond radiotherapy

Multiple new options are available in the palliation of bone metastases. Most of these techniques can be used in conjunction with radiation therapy either before or after and are now giving patients who have reached dose limitations new options. These techniques can also be used with vertebroplasty (VP) to increase structural stability post tumor ablation. Localized percutaneous treatment in the bone such as thermal [radiofrequency ablation (RFA)] and light [photodynamic therapy (PDT)] have been used to destroy tumor prior to injection with cement. This educational review will discuss the safety profile, technique and indications for emerging technology in the area of locoregional treatment of bone metastases in conjunction with vertebral augmentation. It will not delve comprehensively into conventional lines of treatment where indications and outcomes have already been well established.