Table of ContentsView AllTable of ContentsAffected BonesSymptomsComplicationsDiagnosisTreatmentPrognosis

Table of ContentsView All

View All

Table of Contents

Affected Bones

Symptoms

Complications

Diagnosis

Treatment

Prognosis

Lung cancer with bonemetastasesrefers to the spread of cancer from theprimary (original) tumorto the bone. The spread of cancer cells occurs either through the bloodstream orlymphatic system(a system of fluids, vessels, and organs that protect the body against foreign invaders).

Bonemetastasesfrom lung cancer affect between 30% and 40% of people withadvanced lung cancer. The bones are the third most common site for metastases, after theliverandadrenal glands, among people with lung cancer.

Although lung cancer that has spread to bone is not curable, there are treatments that can lengthen survival times and improve quality of life. Moreover, it’s important to note that bone metastases are not all the same. Some have more favorable outcomes than others.

stockdevil / Getty Images

Spine metastasis (cancer spread to thoracic spine)

This article points out which bones lung cancer are likely to affect and which symptoms and complications are likely to appear. It also explains how the condition is diagnosed and treated.

Clear Any ConfusionLung cancer with bone metastases is not the same thing asbone cancer, in which cancer originates in the bones.

Clear Any Confusion

Lung cancer with bone metastases is not the same thing asbone cancer, in which cancer originates in the bones.

Verywell / Ellen Lindner

lung cancer with bone metastases symptoms

According to a review in Therapeutic Advances in Medical Oncology,the most common bones to which lung cancer spreads include (in order of frequency) the:

Lung cancer can also spread to bones in the hands and feet.

Where Lung Cancer Can Spread

Symptoms of Bone Metastases From Lung Cancer

Pain is typically the first symptom of bone metastases. At least, it is in about 80% of cases.The pain may initially feel like a dull muscle strain but gradually intensifies and becomes severe. The pain is often worse at night or with movement.

Symptoms and Complications of Lung Cancer

Bone metastases from lung cancer can cause severe complications as the malignancy progresses. These complications undermine the spine and the integrity of the bones and cause metabolic changes that can compromise a person’s ability to function.

Cauda Equina Syndrome

Metastatic spinal cord compression (MSCC) can often present as a medical emergency. There may initially be localizededema(swelling around the site of the compression) and venous congestion (the disruption of normal blood flow). If treated early, these conditions can be reversed.

However, prolonged venous congestion due to MSCC can lead to severe vascular injury, spinal cordnecrosis(tissue death), and permanent spinal cord damage.

In rare cases, metastatic spinal cord compression can lead tocauda equina syndrome, resulting in limb weakness,sciatica(radiating pain in the lower back and legs), the loss of reflexes in lower extremities, and the loss of bowel and/or bladder function.

Prompt Reaction MattersCauda equine syndrome is considered a medical emergency. If not treated promptly (typically with surgery), the symptoms can become permanent.

Prompt Reaction Matters

Cauda equine syndrome is considered a medical emergency. If not treated promptly (typically with surgery), the symptoms can become permanent.

Pathological Fractures

Why Does Metastasis Happen?

Hypercalcemia and Anemia

The breakdown of bone and the release of calcium into the bloodstream can cause a condition known ashypercalcemia(abnormally high blood calcium). Symptoms include extreme thirst, weakness, nausea or vomiting, decreased urination, and muscle and joint aches.

In people with bone metastases, hypercalcemia is considered a medical emergency and can lead tocardiac arrhythmia(abnormal heart rhythm), disorientation, and even death if not appropriately treated.

Understanding Cancer Fatigue

Bone metastases from lung cancer are diagnosed with imaging studies. In addition to confirming that cancer has spread to the bones, imaging studies can help identify the type of bone metastases involved. Imaging tests used for the diagnosis of bone metastases include:

Primary Tumor Holds the KeyTissue biopsyand histology (the microscopic examination of tissues and cells) are not typically used in cases of bone metastasis unless the site of the primary tumor is unknown.

Primary Tumor Holds the Key

Tissue biopsyand histology (the microscopic examination of tissues and cells) are not typically used in cases of bone metastasis unless the site of the primary tumor is unknown.

Classification

The classification of bone metastases can help doctors predict the likely course and outcome of the disease. Unlikelung cancer staging, the classification of bone metastases does not direct how the disease is treated. Rather, it gives the doctor an idea of how the metastases will progress.

Bone metastases are typically classified based on imaging studies as follows:

Of the three, sclerotic metastases (also referred to as osteoblastic metastases) tend to progress more slowly than osteolytic metastases. Moreover, sclerotic metastases are less commonly associated with hypercalcemia than osteolytic metastases, which can actively leach calcium into the bloodstream.

How Lung Cancer Is Diagnosed

The treatment for lung cancer with bone metastases is primarilypalliative—that is, it’s meant to relieve symptoms rather than cure cancer. The primary goal of treatment is to reduce pain and either prevent or treat fractures and other serious complications.

With this said, for people with only a few metastases (referred to asoligometastaticdisease),oncologistsmay consider treating the metastases aggressively with the hope of long-term survival.

Treatment options for bone metastases can be broadly classified as being either systemic (involving the whole body) or local (involving bone or bone-related symptoms).

Systemic Treatments

For most people with bone metastases, the treatment of the primary tumor may not only help control the spread of the disease but also provide pain relief. Common options include:

Consider a Clinical TrialClinical trialsmight be worth considering if you have advanced lung cancer with metastases, particularly if your current therapies aren’t providing adequate control of the disease.

Consider a Clinical Trial

Clinical trialsmight be worth considering if you have advanced lung cancer with metastases, particularly if your current therapies aren’t providing adequate control of the disease.

Local Treatments

The local treatment of bone metastases is mainly directed at providing pain relief and preventing fractures and spinal compression. Options include:

The median survival time for people with bone metastases from lung cancer—that is, the amount of time after which 50% of people are alive and 50% have died—has increased in recent years. The increase is due to the ever-growing range of cancer treatment options. However, it still hovers at about 10 months.

It’s important to remember that some people have survived and lived a good life for many years beyond this prognosis. Your general health at the time of the diagnosis and during treatment can play a large part in determining how long you can live successfully with the disease.

Survival Times VarySurvival times are somewhat longer forwomenand people under 60 as well as those withlungadenocarcinoma, a single metastasis, or no history of fractures.People with sclerotic bone lesions also tend to survive longer than those with osteolytic or mixed bone metastases.

Survival Times Vary

Survival times are somewhat longer forwomenand people under 60 as well as those withlungadenocarcinoma, a single metastasis, or no history of fractures.People with sclerotic bone lesions also tend to survive longer than those with osteolytic or mixed bone metastases.

Summary

Lung cancer with bone metastases refers to the spread of cancer from theprimary (original) tumorto the bone. The most common bones to which lung cancer spreads include the spine, ribs, ilium, sacrum, femur, humerus, scapula, and sternum. The spread of cancer cells occurs either through the bloodstream or lymphatic system. Pain is typically the first symptom of bone metastases. At least it is in about 80% of cases. The pain may initially feel like a dull muscle strain but gradually intensifies and becomes severe. The pain is often worse at night or with movement.

Bone metastases from lung cancer can cause severe complications as the malignancy progresses. These complications undermine the spine and the integrity of the bones and cause metabolic changes that can compromise a person’s ability to function. Bone metastases from lung cancer are diagnosed with imaging studies, after which treatment is primarily designed to relieve the symptoms rather than cure the cancer. The options can be broadly classified as being either systemic (involving the whole body) or local (involving bone or bone-related symptoms).

A Word From Verywell

Having bone metastases from lung cancer means that your cancer isstage 4and no longer curable. As difficult as it is to hear this news, don’t give up hope. With properly staged palliative care, you can maintain a good quality of life with the support of your family and friends.

To help you through the rough times, join asupport groupof others who understand what you’re going through. Seek counseling from a psychologist or psychiatrist if you’re depressed, anxious, or unable to cope. Try not to focus on survival times. Instead, make every effort to care for yourself emotionally and physically so that you can continue to live the best life you can—probably like you have up to this point.

23 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Milovanovic IS, Stjepanovic M, Mitrovic D.Distribution patterns of the metastases of the lung carcinoma in relation to histological type of the primary tumor: an autopsy study.Ann Thorac Med. 2017;12(3):191-8. doi:10.4103/atm.ATM_276_16.D’Antonio C, Passaro A, Gori B, et al.Bone and brain metastasis in lung cancer: recent advances in therapeutic strategies.Ther Adv Med Oncol. 2014;6(3):101-14. doi:10.1177/1758834014521110.El Abiad JM, Aziz K, Levin AS, McCarthy EM, Morris CD.Osseous metastatic disease to the hands and feet.Orthopedics. 2019;42(2):e197-e201. doi:10.3928/01477447-20181227-04.Jayarangaiah A, Kemp AK, Theetha Kariyanna P.Bone metastasis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.Robson P.Metastatic spinal cord compression: a rare but important complication of cancer.Clin Med (Lond). 2014;14(5):542-5. doi:10.7861/clinmedicine.14-5-542.Liu Y, Wang B, Qian Y, Di D, Wang M, Zhang X.Cauda equine syndrome as the primary symptom of leptomeningeal metastases from lung cancer: A case report and review of literature.Onco Targets Ther. 2018;11:5009-13. doi:10.2147/OTT.S165299.Alokaily F.Pathological fracture.Saudi Med J. 2015;36(1):124-5. doi:10.15537/smj.2015.1.11249.Seccareccia D.Cancer-related hypercalcemia.Can Fam Physician.2010;56(3):244-6, e90-2.Lukaszewski B, Nazar J, Goch M, Lukaszewska M, Stępiński A, Jurczyk MU.Diagnostic methods for detection of bone metastases.Contemp Oncol (Pozn). 2017;21(2):98-103. doi:10.5114/wo.2017.68617.Suva LJ, Washam C, Nicholas RW, Griffin RJ.Bone metastasis: mechanisms and therapeutic opportunities.Nat Rev Endocrinol. 2011;7(4):208-18. doi:10.1038/nrendo.2010.227.Shirasawa M, Fukui T, Kusuhara S, et al.Prognostic differences between oligometastatic and polymetastatic extensive disease-small cell lung cancer.PLoS ONE. 2019;14(4):e0214599. doi:10.1371/journal.pone.0214599.National Cancer Institute.Targeted therapy to treat cancer.American Cancer Society.Immunotherapy for non-small cell lung cancer.Ahmad I, Ahmed MM, Ahsraf MF, et al.Pain management in metastatic bone disease: a literature review.Cureus. 2018;10(9):e3286. doi:10.7759/cureus.3286.Lim FMY, Bobrowski A, Agarwal A, Silva MF.Use of corticosteroids for pain control in cancer patients with bone metastases: a comprehensive literature review.Curr Opin Support Palliat Care. 2017;11(2):78-87. doi:10.1097/SPC.0000000000000263.National Cancer Institute.When cancer spreads to bone, a single dose of radiation therapy may control pain.Nguyen QN, Chun SG, Chow E, et al.Single-fraction stereotactic vs conventional multifraction radiotherapy for pain relief in patients with predominantly nonspine bone metastases: a randomized phase 2 trial.JAMA Oncol. 2019;5(6):872-8. doi:10.1001/jamaoncol.2019.0192.Ricardi U, Badellino S, Filippi AR.Clinical applications of stereotactic radiation therapy for oligometastatic cancer patients: a disease-oriented approach.J Radiat Res. 2016;57(S1):i58-68. doi:10.1093/jrr/rrw006.Von Moos R, Costa L, Gonzalez-Suarez E, Terpos E, Niepel D, Body JJ.Management of bone health in solid tumours: from bisphosphonates to a monoclonal antibody.Cancer Treat Rev. 2019;76:57-67. doi:10.1016/j.ctrv.2019.05.003.Mansoorinasab M, Abdolhoseinpour H.A review and update of vertebral fractures due to metastatic tumors of various sites to the spine: percutaneous vertebroplasty.Interv Med Appl Sci. 2018;10(1):1-6. doi:10.1556/1646.10.2018.03.Cho YJ, Cho YM, Kim SH, Shin KH, Jung ST, Kim HS.Clinical analysis of patients with skeletal metastasis of lung cancer.BMC Cancer. 2019;19(1):303. doi:10.1186/s12885-019-5534-3.Nguyen QN, Chun SG, Chow E, et al.Single-fraction stereotactic vs conventional multifraction radiotherapy for pain relief in patients with predominantly nonspine bone metastases: a randomized phase 2 trial.JAMA Oncol. 2019;5(6):872-878. doi:10.1001/jamaoncol.2019.0192.Yucel B, Celasun MG, Oztoprak B, et al.The negative prognostic impact of bone metastasis with a tumor mass.Clinics (Sao Paulo). 2015 Aug;70(8):535-40. doi:10.6061/clinics/2015(08)01.

23 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Milovanovic IS, Stjepanovic M, Mitrovic D.Distribution patterns of the metastases of the lung carcinoma in relation to histological type of the primary tumor: an autopsy study.Ann Thorac Med. 2017;12(3):191-8. doi:10.4103/atm.ATM_276_16.D’Antonio C, Passaro A, Gori B, et al.Bone and brain metastasis in lung cancer: recent advances in therapeutic strategies.Ther Adv Med Oncol. 2014;6(3):101-14. doi:10.1177/1758834014521110.El Abiad JM, Aziz K, Levin AS, McCarthy EM, Morris CD.Osseous metastatic disease to the hands and feet.Orthopedics. 2019;42(2):e197-e201. doi:10.3928/01477447-20181227-04.Jayarangaiah A, Kemp AK, Theetha Kariyanna P.Bone metastasis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.Robson P.Metastatic spinal cord compression: a rare but important complication of cancer.Clin Med (Lond). 2014;14(5):542-5. doi:10.7861/clinmedicine.14-5-542.Liu Y, Wang B, Qian Y, Di D, Wang M, Zhang X.Cauda equine syndrome as the primary symptom of leptomeningeal metastases from lung cancer: A case report and review of literature.Onco Targets Ther. 2018;11:5009-13. doi:10.2147/OTT.S165299.Alokaily F.Pathological fracture.Saudi Med J. 2015;36(1):124-5. doi:10.15537/smj.2015.1.11249.Seccareccia D.Cancer-related hypercalcemia.Can Fam Physician.2010;56(3):244-6, e90-2.Lukaszewski B, Nazar J, Goch M, Lukaszewska M, Stępiński A, Jurczyk MU.Diagnostic methods for detection of bone metastases.Contemp Oncol (Pozn). 2017;21(2):98-103. doi:10.5114/wo.2017.68617.Suva LJ, Washam C, Nicholas RW, Griffin RJ.Bone metastasis: mechanisms and therapeutic opportunities.Nat Rev Endocrinol. 2011;7(4):208-18. doi:10.1038/nrendo.2010.227.Shirasawa M, Fukui T, Kusuhara S, et al.Prognostic differences between oligometastatic and polymetastatic extensive disease-small cell lung cancer.PLoS ONE. 2019;14(4):e0214599. doi:10.1371/journal.pone.0214599.National Cancer Institute.Targeted therapy to treat cancer.American Cancer Society.Immunotherapy for non-small cell lung cancer.Ahmad I, Ahmed MM, Ahsraf MF, et al.Pain management in metastatic bone disease: a literature review.Cureus. 2018;10(9):e3286. doi:10.7759/cureus.3286.Lim FMY, Bobrowski A, Agarwal A, Silva MF.Use of corticosteroids for pain control in cancer patients with bone metastases: a comprehensive literature review.Curr Opin Support Palliat Care. 2017;11(2):78-87. doi:10.1097/SPC.0000000000000263.National Cancer Institute.When cancer spreads to bone, a single dose of radiation therapy may control pain.Nguyen QN, Chun SG, Chow E, et al.Single-fraction stereotactic vs conventional multifraction radiotherapy for pain relief in patients with predominantly nonspine bone metastases: a randomized phase 2 trial.JAMA Oncol. 2019;5(6):872-8. doi:10.1001/jamaoncol.2019.0192.Ricardi U, Badellino S, Filippi AR.Clinical applications of stereotactic radiation therapy for oligometastatic cancer patients: a disease-oriented approach.J Radiat Res. 2016;57(S1):i58-68. doi:10.1093/jrr/rrw006.Von Moos R, Costa L, Gonzalez-Suarez E, Terpos E, Niepel D, Body JJ.Management of bone health in solid tumours: from bisphosphonates to a monoclonal antibody.Cancer Treat Rev. 2019;76:57-67. doi:10.1016/j.ctrv.2019.05.003.Mansoorinasab M, Abdolhoseinpour H.A review and update of vertebral fractures due to metastatic tumors of various sites to the spine: percutaneous vertebroplasty.Interv Med Appl Sci. 2018;10(1):1-6. doi:10.1556/1646.10.2018.03.Cho YJ, Cho YM, Kim SH, Shin KH, Jung ST, Kim HS.Clinical analysis of patients with skeletal metastasis of lung cancer.BMC Cancer. 2019;19(1):303. doi:10.1186/s12885-019-5534-3.Nguyen QN, Chun SG, Chow E, et al.Single-fraction stereotactic vs conventional multifraction radiotherapy for pain relief in patients with predominantly nonspine bone metastases: a randomized phase 2 trial.JAMA Oncol. 2019;5(6):872-878. doi:10.1001/jamaoncol.2019.0192.Yucel B, Celasun MG, Oztoprak B, et al.The negative prognostic impact of bone metastasis with a tumor mass.Clinics (Sao Paulo). 2015 Aug;70(8):535-40. doi:10.6061/clinics/2015(08)01.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Milovanovic IS, Stjepanovic M, Mitrovic D.Distribution patterns of the metastases of the lung carcinoma in relation to histological type of the primary tumor: an autopsy study.Ann Thorac Med. 2017;12(3):191-8. doi:10.4103/atm.ATM_276_16.D’Antonio C, Passaro A, Gori B, et al.Bone and brain metastasis in lung cancer: recent advances in therapeutic strategies.Ther Adv Med Oncol. 2014;6(3):101-14. doi:10.1177/1758834014521110.El Abiad JM, Aziz K, Levin AS, McCarthy EM, Morris CD.Osseous metastatic disease to the hands and feet.Orthopedics. 2019;42(2):e197-e201. doi:10.3928/01477447-20181227-04.Jayarangaiah A, Kemp AK, Theetha Kariyanna P.Bone metastasis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.Robson P.Metastatic spinal cord compression: a rare but important complication of cancer.Clin Med (Lond). 2014;14(5):542-5. doi:10.7861/clinmedicine.14-5-542.Liu Y, Wang B, Qian Y, Di D, Wang M, Zhang X.Cauda equine syndrome as the primary symptom of leptomeningeal metastases from lung cancer: A case report and review of literature.Onco Targets Ther. 2018;11:5009-13. doi:10.2147/OTT.S165299.Alokaily F.Pathological fracture.Saudi Med J. 2015;36(1):124-5. doi:10.15537/smj.2015.1.11249.Seccareccia D.Cancer-related hypercalcemia.Can Fam Physician.2010;56(3):244-6, e90-2.Lukaszewski B, Nazar J, Goch M, Lukaszewska M, Stępiński A, Jurczyk MU.Diagnostic methods for detection of bone metastases.Contemp Oncol (Pozn). 2017;21(2):98-103. doi:10.5114/wo.2017.68617.Suva LJ, Washam C, Nicholas RW, Griffin RJ.Bone metastasis: mechanisms and therapeutic opportunities.Nat Rev Endocrinol. 2011;7(4):208-18. doi:10.1038/nrendo.2010.227.Shirasawa M, Fukui T, Kusuhara S, et al.Prognostic differences between oligometastatic and polymetastatic extensive disease-small cell lung cancer.PLoS ONE. 2019;14(4):e0214599. doi:10.1371/journal.pone.0214599.National Cancer Institute.Targeted therapy to treat cancer.American Cancer Society.Immunotherapy for non-small cell lung cancer.Ahmad I, Ahmed MM, Ahsraf MF, et al.Pain management in metastatic bone disease: a literature review.Cureus. 2018;10(9):e3286. doi:10.7759/cureus.3286.Lim FMY, Bobrowski A, Agarwal A, Silva MF.Use of corticosteroids for pain control in cancer patients with bone metastases: a comprehensive literature review.Curr Opin Support Palliat Care. 2017;11(2):78-87. doi:10.1097/SPC.0000000000000263.National Cancer Institute.When cancer spreads to bone, a single dose of radiation therapy may control pain.Nguyen QN, Chun SG, Chow E, et al.Single-fraction stereotactic vs conventional multifraction radiotherapy for pain relief in patients with predominantly nonspine bone metastases: a randomized phase 2 trial.JAMA Oncol. 2019;5(6):872-8. doi:10.1001/jamaoncol.2019.0192.Ricardi U, Badellino S, Filippi AR.Clinical applications of stereotactic radiation therapy for oligometastatic cancer patients: a disease-oriented approach.J Radiat Res. 2016;57(S1):i58-68. doi:10.1093/jrr/rrw006.Von Moos R, Costa L, Gonzalez-Suarez E, Terpos E, Niepel D, Body JJ.Management of bone health in solid tumours: from bisphosphonates to a monoclonal antibody.Cancer Treat Rev. 2019;76:57-67. doi:10.1016/j.ctrv.2019.05.003.Mansoorinasab M, Abdolhoseinpour H.A review and update of vertebral fractures due to metastatic tumors of various sites to the spine: percutaneous vertebroplasty.Interv Med Appl Sci. 2018;10(1):1-6. doi:10.1556/1646.10.2018.03.Cho YJ, Cho YM, Kim SH, Shin KH, Jung ST, Kim HS.Clinical analysis of patients with skeletal metastasis of lung cancer.BMC Cancer. 2019;19(1):303. doi:10.1186/s12885-019-5534-3.Nguyen QN, Chun SG, Chow E, et al.Single-fraction stereotactic vs conventional multifraction radiotherapy for pain relief in patients with predominantly nonspine bone metastases: a randomized phase 2 trial.JAMA Oncol. 2019;5(6):872-878. doi:10.1001/jamaoncol.2019.0192.Yucel B, Celasun MG, Oztoprak B, et al.The negative prognostic impact of bone metastasis with a tumor mass.Clinics (Sao Paulo). 2015 Aug;70(8):535-40. doi:10.6061/clinics/2015(08)01.

Milovanovic IS, Stjepanovic M, Mitrovic D.Distribution patterns of the metastases of the lung carcinoma in relation to histological type of the primary tumor: an autopsy study.Ann Thorac Med. 2017;12(3):191-8. doi:10.4103/atm.ATM_276_16.

D’Antonio C, Passaro A, Gori B, et al.Bone and brain metastasis in lung cancer: recent advances in therapeutic strategies.Ther Adv Med Oncol. 2014;6(3):101-14. doi:10.1177/1758834014521110.

El Abiad JM, Aziz K, Levin AS, McCarthy EM, Morris CD.Osseous metastatic disease to the hands and feet.Orthopedics. 2019;42(2):e197-e201. doi:10.3928/01477447-20181227-04.

Jayarangaiah A, Kemp AK, Theetha Kariyanna P.Bone metastasis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

Robson P.Metastatic spinal cord compression: a rare but important complication of cancer.Clin Med (Lond). 2014;14(5):542-5. doi:10.7861/clinmedicine.14-5-542.

Liu Y, Wang B, Qian Y, Di D, Wang M, Zhang X.Cauda equine syndrome as the primary symptom of leptomeningeal metastases from lung cancer: A case report and review of literature.Onco Targets Ther. 2018;11:5009-13. doi:10.2147/OTT.S165299.

Alokaily F.Pathological fracture.Saudi Med J. 2015;36(1):124-5. doi:10.15537/smj.2015.1.11249.

Seccareccia D.Cancer-related hypercalcemia.Can Fam Physician.2010;56(3):244-6, e90-2.

Lukaszewski B, Nazar J, Goch M, Lukaszewska M, Stępiński A, Jurczyk MU.Diagnostic methods for detection of bone metastases.Contemp Oncol (Pozn). 2017;21(2):98-103. doi:10.5114/wo.2017.68617.

Suva LJ, Washam C, Nicholas RW, Griffin RJ.Bone metastasis: mechanisms and therapeutic opportunities.Nat Rev Endocrinol. 2011;7(4):208-18. doi:10.1038/nrendo.2010.227.

Shirasawa M, Fukui T, Kusuhara S, et al.Prognostic differences between oligometastatic and polymetastatic extensive disease-small cell lung cancer.PLoS ONE. 2019;14(4):e0214599. doi:10.1371/journal.pone.0214599.

National Cancer Institute.Targeted therapy to treat cancer.

American Cancer Society.Immunotherapy for non-small cell lung cancer.

Ahmad I, Ahmed MM, Ahsraf MF, et al.Pain management in metastatic bone disease: a literature review.Cureus. 2018;10(9):e3286. doi:10.7759/cureus.3286.

Lim FMY, Bobrowski A, Agarwal A, Silva MF.Use of corticosteroids for pain control in cancer patients with bone metastases: a comprehensive literature review.Curr Opin Support Palliat Care. 2017;11(2):78-87. doi:10.1097/SPC.0000000000000263.

National Cancer Institute.When cancer spreads to bone, a single dose of radiation therapy may control pain.

Nguyen QN, Chun SG, Chow E, et al.Single-fraction stereotactic vs conventional multifraction radiotherapy for pain relief in patients with predominantly nonspine bone metastases: a randomized phase 2 trial.JAMA Oncol. 2019;5(6):872-8. doi:10.1001/jamaoncol.2019.0192.

Ricardi U, Badellino S, Filippi AR.Clinical applications of stereotactic radiation therapy for oligometastatic cancer patients: a disease-oriented approach.J Radiat Res. 2016;57(S1):i58-68. doi:10.1093/jrr/rrw006.

Von Moos R, Costa L, Gonzalez-Suarez E, Terpos E, Niepel D, Body JJ.Management of bone health in solid tumours: from bisphosphonates to a monoclonal antibody.Cancer Treat Rev. 2019;76:57-67. doi:10.1016/j.ctrv.2019.05.003.

Mansoorinasab M, Abdolhoseinpour H.A review and update of vertebral fractures due to metastatic tumors of various sites to the spine: percutaneous vertebroplasty.Interv Med Appl Sci. 2018;10(1):1-6. doi:10.1556/1646.10.2018.03.

Cho YJ, Cho YM, Kim SH, Shin KH, Jung ST, Kim HS.Clinical analysis of patients with skeletal metastasis of lung cancer.BMC Cancer. 2019;19(1):303. doi:10.1186/s12885-019-5534-3.

Nguyen QN, Chun SG, Chow E, et al.Single-fraction stereotactic vs conventional multifraction radiotherapy for pain relief in patients with predominantly nonspine bone metastases: a randomized phase 2 trial.JAMA Oncol. 2019;5(6):872-878. doi:10.1001/jamaoncol.2019.0192.

Yucel B, Celasun MG, Oztoprak B, et al.The negative prognostic impact of bone metastasis with a tumor mass.Clinics (Sao Paulo). 2015 Aug;70(8):535-40. doi:10.6061/clinics/2015(08)01.

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