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Heterotopic ossification (HTO) is the dystrophic formation of mature lamellar bone outside the confines of normal osseous tissues. It is frequently a complication which occurs following traumatic insult, both iatrogenic and non-iatrogenic, and neurological compromise. While mild degree of disease is often asymptomatic, significant pain and mobility limitations may result in reduced quality of life in advanced cases. Currently, the commonly accepted management for patients experiencing significant symptomatic HTOs is a combination therapy of surgical excision with prophylactic radiotherapy in the immediate perioperative period. In this article, we present a patient who achieved satisfactory pain relief and improvements in overall quality of life with the sole use of external beam radiation to illustrate the possibility of using radiotherapy alone for symptomatic management of HTO.

Bone metastases are a common complication of advanced malignancy; however, presentation of below-the-knee metastases, particularly affecting the fibula and tibia, are infrequently observed in both the clinical setting and the literature, and present a therapeutic challenge to patients and physicians alike. Due to the weight-bearing capacity of bones below-the-knee, the disruption of the structural and functional integrity of these bones can reduce mobility and thus quality of life. Treatment options for these patients include surgery, radiotherapy, and/or chemotherapy. Candidates for surgery typically have affected weightbearing bones. For patients not suitable for surgery, radiotherapy is prescribed for pain relief and bone remineralization. Herein, we report four cases in which two female and two male patients developed painful below knee metastases. Orthopedic surgery was consulted for all cases. Two patients underwent surgical fixation followed by radiotherapy, while the other two received palliative radiotherapy alone.

Appendiceal adenocarcinoma (AA) is a rare cancer, accounting for less than 0.5% of all gastrointestinal cancers. As such, there is still debate surrounding both the nature of the disease and the roles of different treatment modalities in the care of this patient population. Metastases of AA, particularly distant metastases, have not been explored extensively in literature. As survival in optimally treated cases of AA continues to improve, clinicians may encounter previously unrealized complications of this disease or unlikely metastases at a higher frequency. We reported the rare case of a 50-year-old male with recurrent mucinous AA who developed painful pelvic bone metastases. To palliate his symptoms, the patient underwent 30 Gy of external beam radiation treatment (EBRT) in 10 fractions to the pelvis. The patient achieved a good pain response after completion of EBRT, with elimination of analgesic use one month post-treatment. This case demonstrates successful palliative management of bone metastases from a primary mucinous AA. Although there is a lack of evidence-based guidelines specific to the treatment of AA, there are a variety of therapies available [e.g., chemotherapy, cytoreductive surgery (CRS), radiation, etc.]. The use of these treatments is largely determined by prognostic factors.

Background: In recent years, stereotactic body radiation therapy (SBRT) has become increasingly used for the management of non-spine bone metastases. Few studies have examined the radiological changes in bone metastases after treatment with SBRT and there is no consensus about what constitutes radiologic response to therapy. This article describes various changes on CT after SBRT to non-spine bone metastases in eight selected cases., Methods: A retrospective review was conducted for patients treated with SBRT to non-spine bone metastases between November 2011 and April 2014 at Sunnybrook Health Sciences Centre. A musculoskeletal radiologist identified eight illustrative cases of interest and provided a description of the findings., Results: Different radiological changes following SBRT were described, including: remineralization of lytic bone metastases, demineralization of sclerotic bone metastases, pathologic fracture, size progression and response in different lesions, as well as lung fibrosis after SBRT to a rib metastasis., Conclusions: We reviewed the radiological images of eight selected cases after SBRT to nonspine bone metastases and a number of characteristic findings were highlighted. We recommend future studies to correlate radiologic changes with clinical outcomes including pain relief, toxicity and long-term local control.