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

Bone mets = pain, spinal cord compression, hypercalcemia, and pathologic fracture. External beam RT (EBRT) can provide significant palliation of painful bone metastases in 50–80% of patients. single-fraction RT schedules compared with longer courses of palliative RT, single- conveince, longer- lower treatment rate. Relative lack of palliative RT guidelines formulated to date, made ASTRO to convene task force into the options for treating bone mets and what treatment strategy one should use. “PubMed database through December 22, 2009 using the Medical Subject Heading term “Radiotherapy bone metastases,” limiting the results to 1998 through 2009. Of the 4,287 articles originally identified” What fractionation schemes- 30 Gy in 10 fractions, 24 Gy in 6 fractions, 20 Gy in 5 fractions, and a single 8-Gy fraction for patients with previously unirradiated painful bone metastases. Fractionated RT courses have been associated with an 8% repeat treatment rate, whilst single # more convienent. When is single fraction RT appropriate- no data to suggest that a single 8-Gy fraction provided inferior pain relief compared with a more prolonged RT course in painful spinal sites. When should patients receive repeat treatment with RT to spinal lesions causing recurrent pain? Care must be taken when the re-irradiated volume contains the spinal cord, and it might be appropriate to sum the biologically effective doses from the initial and repeat treatment regimens to estimate the risk of radiation myelopathy Surgery and EBRT for spinal cord compression. longer schedules, such as 30 Gy in 10 fractions, have been the most commonly used because the intent will be to eradicate microscopic residual disease rather than relieve symptoms, as surgery decompression cares for the macroscopic disease. Surgical decompression and stabilization plus postoperative RT should be considered for selected patients with single-level spinal cord compression or spinal instability Ref http://www.sciencedirect.com/science/article/pii/S0360301610035777