Palliative Radiotherapy for Bone Metastases: An ASTRO Evidence-Based Guideline

Cancer-related pain management in clinical oncology

“…76 Single fraction radiation is recommended over multiple-fraction regimens for the treatment of metastatic bone pain. 77 Tere is no diference in the duration of or time to pain relief between single large fraction radiation and conventional radiation treatments involving mul- 86 tiple fractions; however, there is a higher retreatment rate in single fraction radiation. 78 Patients should also be aware of a possible transient increase in pain at the treatment site, which may be decreased with NSAIDs or corticosteroids.…”

Management of bone metastases: recent advances and current status

“…Pain is the most common symptom patients develop from bone metastases, and the gold standard therapy for its palliation remains conventional external beam radiotherapy (EBRT) [3,4]. Radiotherapy can also restore and preserve physical functioning, provide local control, and maintain and improve skeletal integrity to reduce the risk of fracture.…”

“…MF schedules had a lower rate of retreatment than SF schedules (8 % vs 20 %), but many contend that the convenience and cost effectiveness of the SF schedule [6], the ability to safely and effectively re-irradiate if necessary, and the durability of the SF pain response [7] especially among patients with shorter life expectancies compensate for this shortcoming [8]. Authors of the guideline for palliative radiotherapy for bone metastases from the American Society for Radiation Oncology (ASTRO) could find no evidence to suggest that single 8 Gy fractions for either spinal or non-spinal bone metastases result in decreased rates of pain relief or increased rates of long-term toxicity [3].…”

“…It further clarifies that there are no data showing an advantage for intensity-modulated radiation therapy, stereotactic body radiation therapy (SBRT), or proton therapy in this setting [4]. Similarly, the ASTRO guideline cautions that the delivery, efficacy, and safety of SBRT for uncomplicated bone metastases are still being established, and that SBRT should only be administered for this indication within a clinical trial [3].…”

“…Surgery is effective in decompressing and stabilizing the spinal cord, nerve roots and vertebral column. Surgery followed by fractionated radiotherapy should be considered [3, 28] for patients with a single level of compression [31], especially those with bony compression or spinal instability, provided that the patient is medically fit, surgically operable and has a good performance status [3,28]. Indeed, a randomized phase III of 101 patients showed that compared to patients treated with radiotherapy alone, those treated with decompressive surgery followed by post-operative radiotherapy were significantly more likely to regain or retain ambulatory ability [31].…”