radiation or screws for fracture?

[Dragonfly2]

Hello ladies! So I have shared that a have a pathologic nondisplaced fracture in my iliac crest where the cancer has been for the past 4+ years. The orthopedic oncologist is advising to wait and see, treat it with Zometa, Piqray, and light exercise, and eventually screws if it continues to aggravate me. The radiation doc wants to schedule a round of radiation to an area that was radiated 4+ years ago.

My gut tells me that more radiation may cause further damage to the bone…one can argue that the Mets caused the bone to break but radiation may not necessarily mend it. Though I’m uncomfortable with this fracture, my pain at this time is low to moderate and controlled by OTC medication

My biggest complaint is a pronounced limp and weakness in the leg which presents its own set of issues. I am unsteady because of this weakness and of course the neuropathy caused by 4 years of treatments.

Has anyone been faced with this kind of choice? Two very disparate treatments that each have their advantages and drawbacks. What are your suggestions and advice from a patient’s point of view. I am aware that surgeons love to cut so they will recommend the surgical intervention…which I am willing to take later if necessary.

thank you all for your kind help in this new twist….🙏🙏🙏🙏🥰

[13plus]

Hi Dragonfly, that's a bit of a hard call but I know what I think I would do if I were in your shoes. I've not heard of rads healing bone, in terms of a fracture (am I missing something?), only helping perhaps with the pain (though that's usually more about the cancer itself in the bone). I would be very wary of getting the same area radiated again, though if all else fails with time maybe you could try it later. I prefer the sound of your orthopedist's advise and hope to hell the drugs heal the bone.

Have you been doing any PT since this happened? I'm thinking the right PT shall help because the muscles support the structure. I would ask the PT to connect with the ortho for guidance on what is appropriate. Perhaps the orthopedist can even suggest a good PT for your situation. Swimming might be very helpful in this situation too if it's available to you, and water exercises because your weight will be supported in the water. Keep us posted! Wishing you the best with it all

[Dragonfly2 in reply to 13plus]

Thank you for your detailed response … you are right in line with all the other writers who are saying that radiation won’t heal a fracture. I think the doc was trying to address the pain he thinks I’m having…yes I have pain but right now I can manage it with OTC drugs…yes, and Zometa is already helping to rebuild that bone. Im reaching out to PT today because I am feeling the weakness in those muscles now…it’s a very specific to the right hip. Thank you

[bikebabe]

Hi Dragonfly - sory that it’s the lesion has become so painful and disruptive and hope treatment is effective. The article above is from leading uk cancer charity and as I thought - you shouldn’t really have radiation to same area but SABR is more focused so it might be worth asking.

Also have you been treated with denosumab or other bone strengtheners - very effective in reducing likelihood/ intensity of bone lesions.

Stereotactic radiation

[Dragonfly2 in reply to bikebabe]

Thank you for the news about SABR…. I will ask about that. And yes, one of the reasons I am already feeling better is the two successive months of Zometa, that bone building med. it’s vital in dealing with bone Mets. Thank you for helpful advice! 🥰

[bikebabe in reply to Dragonfly2]

I’m struggling to understand why you weren’t on it from the get-go as it’s supposed to reduce likelihood/growth of bone mets. Comes with risks but my mouthful of 35 yr old crowns and fillings has been ok for last 3 yrs.

[Dragonfly2 in reply to bikebabe]

oh I had been on Zometa (the bone strengthened) for three years..but last fall the ONC felt that I needed a break from it…and I underwent a change from IBrance to Piqray, as well as some radiation to sacrum…so I had this 6 month break. In May , two months after a successful spinal stenosis surgery, the pelvic pain began to return. So I had a Zometa dose in May and yet again just a couple of days ago in June. I have to tell you that I believe the Zometa is akin to magic. I’m feeling soo much better, limp is improving and pain is down to one or zero with Tylenol and naproxen. So, no worries , other than a 6 month hiatus I am back on Zometa and , you are right, it’s a game changer as it rebuilds bone that is being broken down by cancer. What a cocktail of drugs to fight this! Piqray for metastasis and Zometa to rebuild bone…thank you so much for responding. I believe that every interaction informs our community and strengthens our understanding about how to fight this disease. 🙏🙏

[kiwi67]

Dragonfly, its your call, but I think I would go with the surgeon who suggested a wait and see approach and also get a referral to an oncological physio. You can always have radiation later if the problem does not resolve, but if you have the radiation first and it causes problems you cannot go back to the past and start again. I hope I've explained what I mean. All the best. Susan

[Dragonfly2 in reply to kiwi67]

Oh my yes, you are so right! Wait and see is so right…already I’m feeling better with a regimen of naproxen and continued light exercise, I am looking into physiological to see how to address the impact of this limp. ! Thank you so much!

[love2golfwell]

I'm so sorry you are faced with these tough decisions. I am not sure what I would do in this case, but I think listening to your gut is a good place to start. I did not think that radiation could be done on a spot that was radiated before. I think it is worth a try for you to follow the advice of the oncologist. I am also wondering if PT would help as 13plus has suggested. I also think swimming would be a great exercise to try. I hope you can figure out what the best course of action is and that whatever you decide will help with the pain and weakness you are experiencing. Sending you hugs and prayers.

[Dragonfly2 in reply to love2golfwell]

Thank you so much…we are like minded on this….im so glad and grateful for your advice and support 🥰

[love2golfwell in reply to Dragonfly2]

You are so welcome. I can only imagine how difficult this must all be for you and you are in my thoughts and prayers. I truly hope you get some type of resolution.

[lovnmycat]

sorry to hear about your pain. I’ve had two bone fusions for spinal fractures decades before bone Mets. Screws worked there for me but it took a few years for all the pain to go away.

I also had bone bone mets everywhere in my spine the last year and a half and they were bad enough to cause a few compression fractures. The Zomeda has helped once the hormone therapy got the Mets under control. Ultimately I did not use radiation for the fear of it causing more fractures. Not the same thing as you but my fractures did heal and I managed the pain without radiation but every situation is different. Good luck!

[Dragonfly2 in reply to lovnmycat]

That is so important to hear! Radiation has played an important role in my treatment but I agree it’s not the answer to this bone fracture. Thank you for helping to make this decision!

[lovnmycat]

I think there are some on this forum that radiation did help but in my case I was able to avoid. Hopefully you hear from both sides and then weigh the options and make the best decision for yourself based on your particular circumstances. Good luck!

[Shafight]

I had surgery for a fracture in my hip in the ball and socket. It was caused by bone Mets. Afterwards I had first time radiation to the area and was told it was to reduce the hip bone Mets. Lots of pain but now after radiation, I have no pain. I too agree that you should listen to your doctor and wait and see.

[Dragonfly2]

Glad your surgery and Radiation has given you relief! Thankfully my ball and join t are pretty much unaffected...early radiation had helped keep the mets in check and my pain was minimized. But that ugly cancer will rear its head again..so you're right, watch and wait and let the zometa do its magic to rebuild the bone. Thank you for for your kind words!

[Winter-Flowers]

Hi There, I am sorry that you are going through this. I would recommend radiation. It should not damage the bone and it will sap the cancer that are damaging the bone. Good luck!