Introduction: Cancer remains a leading cause of global mortality, and bone metastases are among the most frequent complications of solid tumors, with incidence rising as survival after primary cancer treatment improves. Since bone metastases usually signal incurable disease, palliative radiotherapy accounting for over half of radiation oncology workloads worldwide is the mainstay of symptom management. While practice patterns have been well documented in North America, Europe, and Oceania, data from Africa remain limited. This study reports the experience of Bogodogo University Teaching Hospital (Burkina Faso) in managing patients receiving radiotherapy for painful bone metastases. Methods: A retrospective observational study included all patients treated with palliative radiotherapy for symptomatic bone metastases. Pain response was assessed against pre-treatment scores using internationally recognized criteria. Collected variables included age, sex, primary tumor site, metastatic site, lesion number, analgesic use, radiation dose/fractionation, and clinical evolution. Asymptomatic bone metastases, symptomatic non-bone metastases, and primary bone cancers were excluded. Follow-up occurred at day 3 and month 1. Results: Among 300 patients treated over one year, 24 (8%) had symptomatic bone metastases (58% male; median age 57.5, range 36 - 87). Prostate (41.67%), lung (33.33%), and breast (25%) cancers were the leading primary sites. The lumbar spine (58%) was the most common metastatic location. CT scan was the predominant imaging modality (66.6%). Most patients received 30 Gy (58%) or 20 Gy (42%). Overall pain response was 66.66% at 72 hours and 83.33% at one month. Discussion/Conclusion: Despite retrospective, single-center limitations and the difficulty of isolating radiotherapy’s effect from adjustments in oral analgesics, our results demonstrate an improvement in pain following radiotherapy of palliative radiotherapy in resource-limited settings. Expanding this research through larger multicenter cohorts will be essential to optimize palliative care delivery regionally.
References
[1]
Sung, H., Ferlay, J., Siegel, R.L., Laversanne, M., Soerjomataram, I., Jemal, A., et al. (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71, 209-249. https://doi.org/10.3322/caac.21660
[2]
Cook, G.J.R. and Thorpe, M.P. (2024) Bone Metastases. The Cancer Journal, 30, 202-209. https://doi.org/10.1097/ppo.0000000000000717
[3]
Deng, M., Ding, H., Zhou, Y., Qi, G. and Gan, J. (2025) Cancer Metastasis to the Bone: Mechanisms and Animal Models (Review). Oncology Letters, 29, 1-12. https://doi.org/10.3892/ol.2025.14967
[4]
Hernandez, R.K., Wade, S.W., Reich, A., Pirolli, M., Liede, A. and Lyman, G.H. (2018) Incidence of Bone Metastases in Patients with Solid Tumors: Analysis of Oncology Electronic Medical Records in the United States. BMC Cancer, 18, Article No. 44. https://doi.org/10.1186/s12885-017-3922-0
[5]
van der Velden, J.M., van der Linden, Y.M., Versteeg, A.L., Verlaan, J., Sophie Gerlich, A., Pielkenrood, B.J., et al. (2018) Evaluation of Effectiveness of Palliative Radiotherapy for Bone Metastases: A Prospective Cohort Study. Journal of Radiation Oncology, 7, 325-333. https://doi.org/10.1007/s13566-018-0363-6
[6]
Kirkbride, P. and Tannock, I.F. (2008) Trials in Palliative Treatment—Have the Goal Posts Been Moved? The Lancet Oncology, 9, 186-187. https://doi.org/10.1016/s1470-2045(08)70041-x
[7]
Westhoff, P.G., de Graeff, A., Monninkhof, E.M., Pomp, J., van Vulpen, M., Leer, J.W.H., et al. (2015) Quality of Life in Relation to Pain Response to Radiation Therapy for Painful Bone Metastases. International Journal of Radiation OncologyBiologyPhysics, 93, 694-701. https://doi.org/10.1016/j.ijrobp.2015.06.024
[8]
Sharma, V., Gaye, P.M., Wahab, S.A., Ndlovu, N., Ngoma, T., Vanderpuye, V., et al. (2008) Patterns of Practice of Palliative Radiotherapy in Africa, Part 1: Bone and Brain Metastases. International Journal of Radiation OncologyBiologyPhysics, 70, 1195-1201. https://doi.org/10.1016/j.ijrobp.2007.07.2381
[9]
Lievens, Y., Kesteloot, K., Rijnders, A., Kutcher, G. and Van den Bogaert, W. (2000) Differences in Palliative Radiotherapy for Bone Metastases within Western European Countries. Radiotherapy and Oncology, 56, 297-303. https://doi.org/10.1016/s0167-8140(00)00215-2
[10]
Chow, E., Danjoux, C., Wong, R., Szumacher, E., Franssen, E., Fung, K., et al. (2000) Palliation of Bone Metastases: A Survey of Patterns of Practice among Canadian Radiation Oncologists. Radiotherapy and Oncology, 56, 305-314. https://doi.org/10.1016/s0167-8140(00)00238-3
[11]
Roos, D.E. (2000) Continuing Reluctance to Use Single Fractions of Radiotherapy for Metastatic Bone Pain: An Australian and New Zealand Practice Survey and Literature Review. Radiotherapy and Oncology, 56, 315-322. https://doi.org/10.1016/s0167-8140(00)00250-4
[12]
Tsao, M.N., Lloyd, N.S. and Wong, R.K. (2005) Clinical Practice Guideline on the Optimal Radiotherapeutic Management of Brain Metastases. BMC Cancer, 5, Article No. 34. https://doi.org/10.1186/1471-2407-5-34
[13]
Maher, E.J. (1991) The Influence of National Attitudes on the Use of Radiotherapy in Advanced and Metastatic Cancer, with Particular Reference to Differences between the United Kingdom and the United States of America: Implications for Future Studies. International Journal of Radiation OncologyBiologyPhysics, 20, 1369-1373. https://doi.org/10.1016/0360-3016(91)90251-x
[14]
Haddad, P., Wong, R.K.S., Pond, G.R., Soban, F., Williams, D., McLean, M., et al. (2005) Factors Influencing the Use of Single vs Multiple Fractions of Palliative Radiotherapy for Bone Metastases: A 5-Year Review. Clinical Oncology, 17, 430-434. https://doi.org/10.1016/j.clon.2005.03.012
[15]
Chow, E., Zeng, L., Salvo, N., Dennis, K., Tsao, M. and Lutz, S. (2012) Update on the Systematic Review of Palliative Radiotherapy Trials for Bone Metastases. Clinical Oncology, 24, 112-124. https://doi.org/10.1016/j.clon.2011.11.004
[16]
Ka, K., Dieng, M.M., Gaye, P.M., Ndong, B., Yessoufou, M.I., Sall, E.H.A., et al. (2021) Analgesic Radiation Therapy for Bone Metastasis in Dakar. World Journal of Advanced Research and Reviews, 11, 220-225. https://doi.org/10.30574/wjarr.2021.11.3.0451
[17]
Ibrahim, H. and Umar, A. (2018) Pattern of Patients Presentation with Metastatic Breast Cancer for Palliative External Beam Radiotherapy in the University College Hospital Ibadan. Annals of Tropical Pathology, 9, 131-134. https://doi.org/10.4103/atp.atp_36_18
[18]
Ryan, C., Stoltzfus, K.C., Horn, S., Chen, H., Louie, A.V., Lehrer, E.J., et al. (2022) Epidemiology of Bone Metastases. Bone, 158, Article ID: 115783. https://doi.org/10.1016/j.bone.2020.115783
[19]
Jiang, W., Rixiati, Y., Zhao, B., Li, Y., Tang, C. and Liu, J. (2020) Incidence, Prevalence, and Outcomes of Systemic Malignancy with Bone Metastases. Journal of Orthopaedic Surgery, 28, 1-5. https://doi.org/10.1177/2309499020915989
[20]
Huang, J., Shen, J., Li, X., Rengan, R., Silvestris, N., Wang, M., et al. (2020) Incidence of Patients with Bone Metastases at Diagnosis of Solid Tumors in Adults: A Large Population-Based Study. Annals of Translational Medicine, 8, 482-482. https://doi.org/10.21037/atm.2020.03.55
[21]
Svensson, E., Christiansen, C.F., Ulrichsen, S.P., R？rth, M.R. and S？rensen, H.T. (2017) Survival after Bone Metastasis by Primary Cancer Type: A Danish Population-Based Cohort Study. BMJ Open, 7, e016022. https://doi.org/10.1136/bmjopen-2017-016022
[22]
Gbané, M., Soglo, J.C., Diomandé, M., Kengni, G.L., Ouattara, B., Kouassi, J.M.D., et al. (2020) Etiologies of Bone Metastases at the Rheumatology Department (UTH) of Abidjan. Open Journal of Rheumatology and Autoimmune Diseases, 10, 1-7. https://doi.org/10.4236/ojra.2020.101001
[23]
Kirakoya, B., Pare, A.K., Abubakar, B.M. and Kabore, M. (2017) Prostate Cancer Presenting with Parietal Bone Metastasis. Case Reports in Urology, 2017, Article ID: 1928570. https://doi.org/10.1155/2017/1928570
[24]
Amoako, Y.A., Hammond, E.N.B., Assasie-Gyimah, A., Laryea, D.O., Ankrah, A. and Amoah, G. (2019) Prostate-Specific Antigen and Risk of Bone Metastases in West Africans with Prostate Cancer. World Journal of Nuclear Medicine, 18, 143-148. https://doi.org/10.4103/wjnm.wjnm_38_18
[25]
McDougall, R.P., Ho, Q., Hsu, C. and Robbins, J.R. (2025) Implications of Primary Tumor Site and Fraction Size on Outcomes of Palliative Radiation for Osseous Metastases. Frontiers in Oncology, 15, Article 1432916. https://doi.org/10.3389/fonc.2025.1432916
[26]
Pesapane, F., Downey, K., Rotili, A., Cassano, E. and Koh, D. (2020) Imaging Diagnosis of Metastatic Breast Cancer. Insights into Imaging, 11, Article No. 79. https://doi.org/10.1186/s13244-020-00885-4
[27]
Roszkowski, N., Lam, S.S., Copson, E., Cutress, R.I. and Oeppen, R. (2021) Expanded Criteria for Pretreatment Staging CT in Breast Cancer. BJS Open, 5, zraa006. https://doi.org/10.1093/bjsopen/zraa006
[28]
Erasmus, L.T., Strange, T.A., Agrawal, R., Strange, C.D., Ahuja, J., Shroff, G.S., et al. (2023) Lung Cancer Staging: Imaging and Potential Pitfalls. Diagnostics, 13, Article 3359. https://doi.org/10.3390/diagnostics13213359
[29]
Yang, H.L., Liu, T., Wang, X.M., Xu, Y. and Deng, S.M. (2011) Diagnosis of Bone Metastases: A Meta-Analysis Comparing 18FDG PET, CT, MRI and Bone Scintigraphy. European Radiology, 21, 2604-2617. https://doi.org/10.1007/s00330-011-2221-4
[30]
Rashidi, A., Baratto, L., Theruvath, A.J., Greene, E.B., Hawk, K.E., Lu, R., et al. (2022) Diagnostic Accuracy of 2-[18F]FDG-PET and Whole-Body DW-MRI for the Detection of Bone Marrow Metastases in Children and Young Adults. European Radiology, 32, 4967-4979. https://doi.org/10.1007/s00330-021-08529-x
[31]
Mourad, C., Cosentino, A., Nicod Lalonde, M. and Omoumi, P. (2023) Advances in Bone Marrow Imaging: Strengths and Limitations from a Clinical Perspective. Seminars in Musculoskeletal Radiology, 27, 3-21. https://doi.org/10.1055/s-0043-1761612
[32]
Anazodo, U.C., Ng, J.J., Ehiogu, B., Obungoloch, J., Fatade, A., Mutsaerts, H.J.M.M., et al. (2023) A Framework for Advancing Sustainable Magnetic Resonance Imaging Access in Africa. NMR in Biomedicine, 36, e4846. https://doi.org/10.1002/nbm.4846
[33]
Brink, A., Kleynhans, J., Grigoryan, A., Omar, W., Mekonnen, B.W., Kolade, O.U., et al. (2025) The Current Status of Nuclear Medicine in Africa. Journal of Nuclear Medicine, 67, 196-203. https://doi.org/10.2967/jnumed.125.271248
[34]
Hovenier, R., Huele, E.H., Bindels, B.J.J., van Oss, A., Kuijten, R.H., Verlaan, J.J., et al. (2026) Pain Response of Patients Treated with Radiotherapy for Painful Bone Metastases between 2013 and 2024—An Analysis of the Prospective Real-World PRESENT Cohort. Radiotherapy and Oncology, 214, Article ID: 111263. https://doi.org/10.1016/j.radonc.2025.111263
[35]
Alemu, H.K., Jemal, A., Assefa, M. and Seife, E. (2025) Patient Reported Change in Pain Outcome among Stage IV Cancer Patients with Bone Metastases Following Palliative Radiotherapy: A Prospective Study from Ethiopia. Translational Oncology, 57, Article ID: 102372. https://doi.org/10.1016/j.tranon.2025.102372
