Palliative radiation therapy for bone metastases

  • Publication
    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.

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    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)

    Resources
    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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    ASTRO guidelines present scientific, health, and safety information and may reflect scientific or medical opinion. They are available to ASTRO members and the public for educational and informational purposes only. Commercial use of any content in this guideline without the prior written consent of ASTRO is strictly prohibited.