Radiosurgical Hypophysectomy for Bone Metasteses Pain

Inclusion Criteria:

1. Cytologic proof of malignancy

2. Radiographic evidence of bone metastases

3. Intractable pain uncontrolled by opioids, medical management, injections/ablation orsurgical intervention that would be difficult to address with conventional radiationtherapy or other standard options and is limiting the patient's function and qualityof life. Intractable pain will be defined as a visual analogue score of at least 4.

4. Definitive radiographic progression of osseous and/or visceral metastases onstandard staging scans (CT, MRI, bone scan, PET scan or any other standard of careimaging) performed within the last 3 months in spite of standard oncologicinterventions and/or inability to tolerate standard oncologic interventions

5. Life expectancy at least 4 weeks

6. Age≥ 18 years

7. Patients of childbearing potential (male or female) must practice adequatecontraception due to possible harmful effects of radiation therapy on an unbornchild

8. Patient must have the ability to understand and the willingness to sign a writteninformed consent document

9. All patients must be informed of the investigational nature of this study and mustbe given written informed consent in accordance with institutional and federalguidelines

Exclusion Criteria:

1. Prior brain radiation

2. Patients must not have a serious medical or psychiatric illness that would, in theopinion of the treating physician prevent informed consent or completion of protocoltreatment

3. Isolated localized pain amenable to focal radiation therapy, or pain well controlledby opioids, medical management, injections/ablation or surgical intervention

4. Malignancies being managed with curative intent

5. Life expectancy <4 weeks

6. The tumor amenable to curative management