Trial explores radiotherapy following surgery for pathological fractures in metastatic bone cancer

Consultants at The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, are at the forefront of research into whether intervening with radiotherapy immediately following surgery to treat pathological fractures reduces pain significantly, compared to no intervention. Approximately 70 per cent of people with advanced breast and prostate cancer develop secondary bone cancer. The disease weakens the bone, causing pathological fractures that require surgery to stabilise or replace the affected bone. Pathological fractures occur when bones break without any causative injury and can be very painful.

The research is being undertaken as part of the PORTRAIT trial (Post Operative Radiotherapy in Surgically Treated Bone Metastases), a multicentre study funded by the National Institute for Health and Care Research (NIHR). The trial is sponsored by The Royal Orthopaedic Hospital and led by chief investigator and orthopaedic oncology consultant Mr Jonathan Stevenson, who commented: “Despite its widespread use, there is no high quality evidence that having radiotherapy after surgery improves pain and quality of life, or reduces the risk of needing another operation.

“Because radiotherapy has side effects, as well as requiring additional hospital visits and scans, it is essential to understand if any benefits justify additional harms and cost.”

Funding of £2.2m from the NIHR will enable the study to recruit 20 sites across the UK in a randomised trial that aims to recruit 350 patients over the age of 18.

Read this report on page 5 of the October 2025 issue of RAD Magazine.