AbstractRadiation is an effective modality for palliation of osseous metastases. Inpatients with a limited number of lesions, local external beam irradiation is the most expedient method of delivering radiation therapy. Complete or partial relief of pain will occur in 80-90% of patients. When metastases are widespread or when new sites continue to appear, localized external irradiation becomes logistically difficult. In such cases, hemibody irradiation has been effective with an overall response rate of 85%. However, nausea, vomiting, diarrhea, and bone marrow and pulmonary toxicity may complicate therapy. In these cases, an effective alternative is systemic phosphorus-32 (32P) or strontium-89 (89Sr). Relief of pain in the range of 60-90% has been reported. Toxicity of32Pis largely that of bone marrow suppression, while89Sr appears to be relatively marrow-sparing. In this review, we consider systemic32P or89Sr as viable options to external beam or hemibody irradiation in the presence of numerous bone metastases.