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Bone metastases (BMs) are the most common cause of cancer-related pain and radiation therapy plays a key role in treating pain caused by it. The half-body irradiation (HBI) is a modality that can be used to treat patients with multiple painful BMs. In the modern era, concerns about toxicity and the availability of new agents requiring robust bone marrow function have limited the use of HBI in advanced cancer. Concerns about HBI toxicity stem from outdated techniques; modern methods like volumetric modulated arc therapy (VMAT) and helical tomotherapy now allow safer irradiation of complex target volumes. We conducted a systematic review to present updated information about HBI efficacy and potential toxicity. Pain relief usually occurs very quickly 2–3 weeks after HBI. The overall pain response rate was high in all the series, accounting for a median of 84 % (75.6–89 %), with a median of 36 % complete pain response. The toxicity is usually limited to G1/G2, with very rare G3 cases. More than 50 % of patients can reduce analgesic intake after HBI. Additionally, with modern radiotherapy techniques, quality of life is improved in most patients. HBI is a safe and effective method and should once again be reconsidered for more frequent use.

Bone metastases (BMs) are the most common cause of cancer-related pain and radiation therapy plays a key role in treating pain caused by it. The half-body irradiation (HBI) is a modality that can be used to treat patients with multiple painful BMs. In the modern era, concerns about toxicity and the availability of new agents requiring robust bone marrow function have limited the use of HBI in advanced cancer. Concerns about HBI toxicity stem from outdated techniques; modern methods like volumetric modulated arc therapy (VMAT) and helical tomotherapy now allow safer irradiation of complex target volumes. We conducted a systematic review to present updated information about HBI efficacy and potential toxicity. Pain relief usually occurs very quickly 2-3 weeks after HBI. The overall pain response rate was high in all the series, accounting for a median of 84 % (75.6-89 %), with a median of 36 % complete pain response. The toxicity is usually limited to G1/G2, with very rare G3 cases. More than 50 % of patients can reduce analgesic intake after HBI. Additionally, with modern radiotherapy techniques, quality of life is improved in most patients. HBI is a safe and effective method and should once again be reconsidered for more frequent use., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Peter Hoskin is supported by NIHR Manchester Biomedical Research Centre. The other authors declare no conflict of interest., (© 2024 The Author(s).)

Abstract: Aims: To determine whether patients receiving hemi-body irradiation required further treatment to painful bone sites out with the radiation field (skull or lower leg), whether patients required further treatment to areas within the treated radiation field for pain or new skeletal events, and whether the treatment outcome was successful in terms of pain control. Toxicities, the need for transfusions and survival were also analysed. Materials and methods: In our retrospective review, 103 men aged 50–87 years, with skeletal metastases from prostate cancer, received modified hemi-body irradiation (HBI) during a consecutive 10-year period, using the same radiotherapy technique and dose. The upper HBI field excluded the region above the ramus of the mandible and the lower HBI field excluded the lower limb below the knee. A successful outcome was determined by assessing the pain response in combination with a change in analgesic intake. Results: Twenty patients received upper HBI; 17/20 (85%) had a successful outcome at the 6-week review, sustained in 94.1% at the final follow-up with no need for radiotherapy to the skull. Thirty-eight patients received lower HBI; 26/38 (68.4%) had a successful outcome at the 6-week review, sustained in 80.8% at the final follow-up with no need for radiotherapy to the lower leg. Forty-five patients received sequential HBI; 33/45 (73.3%) had a successful outcome at the 6-week review, sustained in 87.9% at the final follow-up, with three patients requiring further radiotherapy to the skull (2/45) or lower leg (1/45). Only 5/103 patients (4.8%) developed new skeletal events in the treated area. Toxicity and transfusion requirements were minimal. Conclusions: Modifying the field size for single-fraction HBI does not have a significant effect on the final outcome of treatment, namely pain control and a need for additional radiotherapy. In our experience, modified HBI should be considered in patients with multiple bone pain sites, especially if they will probably require several visits for localised radiotherapy to single painful bone sites within a short period of time. [Copyright &y& Elsevier]