Radiotherapy is a successful and time-efficient means by which to palliate pain and/or prevent the morbidity of bone metastases, according to the American Society for Radiation Oncology (ASTRO). ASTRO developed a formal treatment guideline for using the treatment appropriately in this context.
After reviewing 4,287 research articles potentially applicable to radiotherapy for bone metastases, an ASTRO task force reached several conclusions, including but not limited to the following:
- External beam radiotherapy (EBRT) continues to be the mainstay of treatment for pain and/or prevention of morbidity caused by bone metastases.
- Both single doses and longer courses of radiation have shown similar pain relief outcomes; single courses are more convenient for patients and caregivers, and longer courses have a lower incidence of repeat treatment to the same sites.
- Stereotactic body radiotherapy holds promise in the treatment of new or recurrent spine lesions; however, its use should be limited to highly selected patients and preferably within a prospective trial.
- Surgical decompression and postoperative radiotherapy is recommended for spinal cord compression or spinal instability in highly selected patients with sufficient performance status and life expectancy.
- The use of bisphosphonates, radionuclides, vertebroplasty, and kyphoplasty for the treatment or prevention of cancer-related symptoms does not eliminate the need for EBRT in appropriate patients.
The guideline, authored by a team led by radiation oncologist Stephen Lutz, MD, of the Blanchard Valley Regional Cancer Center in Findlay, Ohio, is published in ASTRO’s International Journal of Radiation Oncology*Biology*Physics (2011;79:965-976).