Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline

Lutz, S; Balboni, Tracy A.; Jones, Joshua; Lo, Simon S.; Petit, Joshua H.; Rich, Shayna E.; Wong, Rebecca; Hahn, Carol A.

doi:10.1016/j.prro.2016.08.001

Cited by 376 publications

(315 citation statements)

References 35 publications

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“…The radiation protocols used here were prescribed based on the best judgment of radiation oncologists considering patient characteristics, including tumor size, and normal tissue response. Interestingly, multiple meta‐analyses of dose‐fractionation trials in people receiving palliative radiotherapy for various tumors, including bone metastasis, lung cancer, and rectal cancer, found that various palliative protocols confer comparable results . There is no evidence that any regimen provides greater or more durable palliation.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, multiple meta-analyses of dose-fractionation trials in people receiving palliative radiotherapy for various tumors, including bone metastasis, lung cancer, and rectal cancer, found that various palliative protocols confer comparable results. [22][23][24][25][26] There is no evidence that any regimen provides greater or more durable palliation.…”

Section: Discussionmentioning

confidence: 99%

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Short survival time following palliative‐intent hypofractionated radiotherapy for non‐resectable canine thyroid carcinoma: A retrospective analysis of 20 dogs

Tsimbas

Turek

Christensen

et al. 2018

Vet Radiology Ultrasound

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Radiotherapy is the treatment of choice for non-resectable canine thyroid carcinoma. High tumor response rates and median survival times of 2 years or longer have been previously reported with conventionally fractionated and hypofractionated protocols, even in dogs with distant metastasis. The objective of this retrospective, descriptive, case series study was to evaluate the clinical outcomes of dogs with thyroid carcinoma irradiated with palliative intent using hypofractionated radiotherapy at our institution. Medical records of 20 dogs treated between 1999 and 2014 were reviewed. All dogs had macroscopic primary tumors and presented with tumor-related clinical signs. Median longest tumor diameter was 10 cm. Nineteen dogs (95%) had metastasis (7/19 lymph node; 16/19 distant metastasis). Most dogs were treated with four weekly fractions of 6.5-8 Gy. Radiotherapy was well tolerated in 17 dogs; three died of respiratory compromise before completing radiotherapy. Eleven dogs received adjuvant chemotherapy. Five dogs experienced a local tumor response including two complete and three partial responses. Overall median survival time was 170 days (range, 1-824 days; 95% CI: 58-392 days). Of potential variables examined (radiation delivery system and protocol, tumor size and location, vascular/lymphatic invasion, metastatic disease, chemotherapy, tumor response), only achievement of complete or partial response was predictive of overall survival. In contrast to previously reported cohorts, dogs with clinical signs and stage IV disease predominated in this study. Previous studies may over-estimate survival following hypofractionated radiotherapy in dogs with advanced thyroid carcinoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Short survival time following palliative‐intent hypofractionated radiotherapy for non‐resectable canine thyroid carcinoma: A retrospective analysis of 20 dogs

Tsimbas

Turek

Christensen

et al. 2018

Vet Radiology Ultrasound

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“…It was concluded that single fraction radiotherapy was as effective as multifraction regimens in palliation of bone metastases but retreatment was more frequent in the single fraction regimen [15-20]. A recent update of the ASTRO (American Society of Therapeutic Radiology and Oncology) evidence-based guideline regarding palliative radiotherapy for painful bone metastases concluded that there was strong evidence of pain relief equivalency between single and multiple fraction regimens for bone metastases [21]. Similar results were observed in our present study wherein there was no statistical difference in complete pain relief (20% in each group) and overall pain relief (80%, 75% and 85% in groups I, II and III, respectively (P = 0.7).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Single Versus Multifraction Radiotherapy in Palliation of Painful Bone Metastases

et al. 2018

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BackgroundBone is a common site of dissemination in advanced cancer accounting for one-third of all distant metastases. Various fractionation schedules of radiotherapy have been used for palliation of bone metastases. The aim of this study was to compare three schedules of external radiation therapy (8 Gy single session versus 20 Gy/5 fractions versus 30 Gy/10 fractions) for palliative management of bone metastases.MethodsIn the present study, 60 patients of bone metastases from any primary site were enrolled and randomly divided into three groups of 20 patients each by draw of lots. These patients received palliative external beam radiation therapy to the involved site. Patients were given 8 Gy single session, 20 Gy/5 fractions/1 week and 30 Gy/10 fractions/2 weeks in groups I, II and III, respectively.ResultsThe percentage of patients with overall pain relief was 80% in group I, 75% in group II and 85% in group III (P = 0.7). The number of patients with complete pain relief was 4 (20%) in each group. Maximum patients got pain relief at 4 weeks post-radiotherapy. The number of patients with improved performance status was 4 (20%) in group II and 2 (10%) each in groups I and III (P = 0.5). Thirteen (65%) patients in each of the groups had decreased analgesic requirement at 2-month follow-up. Retreatment rate was more in the single fraction (20%) compared to only 5% in group II and none in the group III (P = 0.05).ConclusionFrom the present study we conclude that 8 Gy single fraction is as effective as multifraction radiotherapy for the palliation of painful bone metastases. However, for a center like ours being the only Government Tertiary Cancer Care Centre in the State, general consensus drawn after this study, recommends external radiation therapy 20 Gy/5 fraction regimen to be an appropriate means of palliation of painful bone metastases.

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“…Palliative radiotherapy (RT) is widely used to alleviate symptoms, especially in patients with painful bone metastasis, and high response rates of 70%‐80% have been reported in these patients . Palliative RT is considered a safe treatment, and severe adverse events associated with palliative RT alone are rare .…”

Section: Introductionmentioning

confidence: 99%

Severe esophageal stenosis in a patient with metastatic colon cancer following palliative radiotherapy, ramucirumab, and chemotherapy

Akahane

Shirai

Wakatsuki

et al. 2020

Clinical Case Reports

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Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline

Cited by 376 publications

References 35 publications

Short survival time following palliative‐intent hypofractionated radiotherapy for non‐resectable canine thyroid carcinoma: A retrospective analysis of 20 dogs

Short survival time following palliative‐intent hypofractionated radiotherapy for non‐resectable canine thyroid carcinoma: A retrospective analysis of 20 dogs

Comparison of Single Versus Multifraction Radiotherapy in Palliation of Painful Bone Metastases

Severe esophageal stenosis in a patient with metastatic colon cancer following palliative radiotherapy, ramucirumab, and chemotherapy

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