External Beam Radiation Therapy for Palliation of Symptomatic Bone Metastases: An ASTRO Clinical Practice Guideline

Sara Alcorn, Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota.
Ángel Artal Cortés, Department of Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Lisa Bradfield, American Society for Radiation Oncology, Arlington, Virginia.
Margaret Brennan, Patient Representative, Baltimore, Maryland.
Kristopher Dennis, Division of Radiation Oncology, Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.
Dayssy A. Diaz, Department of Radiation Oncology, Ohio State University, Columbus, Ohio.
Yee-Cheen Doung, Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon.
Shekinah Elmore, Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
Lauren Hertan, Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Candice Johnstone, Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Joshua Jones, Rochester Regional HealthFollow
Nicole Larrier, Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
Simon S. Lo, Department of Radiation Oncology, University of Washington, Seattle, Washington.
Quynh-Nhu Nguyen, Department of Radiation Oncology, University of Texas - MD Anderson Cancer Center, Houston, Texas.
Yolanda D. Tseng, Department of Radiation Oncology, University of Washington, Seattle, Washington.
Divya Yerramilli, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Sandra Zaky, Department of Radiation Oncology, Stanford University, Stanford, California.
Tracy Balboni, Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.

Department

Radiation Oncology

Document Type

Article

Publication Title

Practical Radiation Oncology

Abstract

PURPOSE: This guideline provides evidence-based recommendations for palliative external beam radiation therapy (RT) in symptomatic bone metastases.

METHODS: The ASTRO convened a task force to address 5 key questions regarding palliative RT in symptomatic bone metastases. Based on a systematic review by the Agency for Health Research and Quality, recommendations using predefined consensus-building methodology were established; evidence quality and recommendation strength were also assessed.

RESULTS: For palliative RT for symptomatic bone metastases, RT is recommended for managing pain from bone metastases and spine metastases with or without spinal cord or cauda equina compression. Regarding other modalities with RT, for patients with spine metastases causing spinal cord or cauda equina compression, surgery and postoperative RT are conditionally recommended over RT alone. Furthermore, dexamethasone is recommended for spine metastases with spinal cord or cauda equina compression. Patients with nonspine bone metastases requiring surgery are recommended postoperative RT. Symptomatic bone metastases treated with conventional RT are recommended 800 cGy in 1 fraction (800 cGy/1 fx), 2000 cGy/5 fx, 2400 cGy/6 fx, or 3000 cGy/10 fx. Spinal cord or cauda equina compression in patients who are ineligible for surgery and receiving conventional RT are recommended 800 cGy/1 fx, 1600 cGy/2 fx, 2000 cGy/5 fx, or 3000 cGy/10 fx. Symptomatic bone metastases in selected patients with good performance status without surgery or neurologic symptoms/signs are conditionally recommended stereotactic body RT over conventional palliative RT. Spine bone metastases reirradiated with conventional RT are recommended 800 cGy/1 fx, 2000 cGy/5 fx, 2400 cGy/6 fx, or 2000 cGy/8 fx; nonspine bone metastases reirradiated with conventional RT are recommended 800 cGy/1 fx, 2000 cGy/5 fx, or 2400 cGy/6 fx. Determination of an optimal RT approach/regimen requires whole person assessment, including prognosis, previous RT dose if applicable, risks to normal tissues, quality of life, cost implications, and patient goals and values. Relatedly, for patient-centered optimization of treatment-related toxicities and quality of life, shared decision making is recommended.

CONCLUSIONS: Based on published data, the ASTRO task force's recommendations inform best clinical practices on palliative RT for symptomatic bone metastases.

First Page

377

Last Page

397

DOI

10.1016/j.prro.2024.04.018

Volume

14

Issue

5

Publication Date

9-1-2024

Medical Subject Headings

Humans; Palliative Care (methods); Bone Neoplasms (secondary, radiotherapy)

PubMed ID

38788923

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