Objectives Bone metastases are common in advanced cancers. In patients with impending pathologic fractures, prophylactic fixation can improve quality of life. Postoperative radiotherapy (RT) is the standard of care for bone metastases; however, preoperative RT may be beneficial in some patients. We evaluated outcomes in patients treated with preoperative RT for bone metastases. Methods We performed a retrospective review of 10 patients with bone metastases treated with preoperative RT. Descriptive statistics were used to characterise the cohort, and the Kaplan-Meier method was used to estimate time to subsequent palliative RT treatment and overall survival. Results 10 patients were included in the analysis. Preoperative RT was used for various reasons, including for continuation of systemic therapy (20%), to reduce the RT field (20%) and due to medical comorbidities delaying surgery (20%). The median time from completion of RT to surgery was 13 days (IQR 7–21). The majority of patients (90%) had no postoperative complications. No patients had radiographic evidence of local disease recurrence at a median of 13 months. Conclusions Patients treated with preoperative RT do well with minimal operative complications and improvement in reported pain. A randomised clinical trial is warranted to compare outcomes for preoperative and postoperative RT for palliation of bone metastasis requiring orthopaedic intervention.
Pearce et al. (2026) studied this question.