Patient Care and Research

ASTRO's guideline on Palliative Radiation Therapy for bone metastases

Online – August 2016
Print – January 2017

This guideline update addresses the eight questions from the original bone metastases guideline published in 2011 based on new literature. It first discusses effective fractionation schemes to treat pain and/or prevent morbidity from peripheral bone metastases. Next, it looks at the appropriateness of RT for bone metastases involving the spine and other critical structures and whether there are long-term side effect risks that should limit use of single fraction RT for bone metastases. In addition, the guideline gives recommendations on retreatment with radiation to both peripheral and spinal bone metastases and the role of highly conformal RT in primary and re-treatment. Finally, the document considers whether surgery, radionuclide, bisphosphonates, or kyphoplasty/vertebroplasty obviate the role of RT in pain bone metastases.

Read full guideline

Quick Reference

  • External beam radio therapy (EBRT)
  • Single- verses multiple-fraction radiation schedules
  • Repeat radiotherapy
  • Stereotactic body radiotherapy (considered but not recommended as primary treatment outside of clinical trials)

Palliative Radiation and Supportive Oncology
Introduction to the use of RT for Palliation of Cancer Related Distress
ASTRO’s SBRT Model Policy

Author Society
American Society for Radiation Oncology

Previous version
Palliative Radiotherapy for bone Metastases: An ASTRO Evidence-Based Guideline  - 2011

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