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ASTRO Guideline on Palliative Radiation Therapy for Bone Metastases - Update

Published: January 2017 (Web posted August 2016)

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This guideline update addresses the 8 questions from the original bone metastases guideline published in 2011 based on new literature. The topics include: 1) effective fractionation schemes to treat pain and/or prevent morbidity from peripheral bone metastases; 2) appropriateness of RT for bone metastases involving the spine and other critical structures; 3) whether there are long-term side effect risks that should limit use of single fraction RT for bone metastases; 4) retreatment with radiation to both peripheral and 5) spinal bone metastases; 6) role of highly conformal RT in primary and 7) retreatment; and 8) whether surgery, radionuclide, bisphosphonates or kyphoplasty/vertebroplasty obviate the role of RT in pain bone metastases.

Key Points:

  • 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 (CME)
ASTRO’s SBRT Model Policy
Patient Brochure

Previous/full guideline:

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

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