Palliative Radiotherapy for Bone Metastases: An ASTRO Evidence-Based Guideline
- Department of Radiation Oncology, Blanchard Valley Regional Cancer Center, Findlay, OH (United States)
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL (United States)
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON (Canada)
- Department of Radiation Oncology, Duke University, Durham, NC (United States)
- Mount Vernon Centre for Cancer Treatment, Middlesex (United Kingdom)
- Department of Radiation Oncology, University of Michigan, Mt. Pleasant, MI (United States)
- Department of Radiation Oncology, Wayne State University, Detroit, MI (United States)
- Department of Radiation Oncology, Boston Medical Center, Boston, MA (United States)
- Department of Radiation Oncology, Ohio State University, Columbus, OH (United States)
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center and the Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada)
- 21st Century Oncology, Sarasota, FL (United States)
- Institute for Palliative Medicine, San Diego Hospice, San Diego, CA (United States)
- Neurological Surgery, Ohio State University, Columbus, OH (United States)
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH (United States)
- University of Pennsylvania School of Nursing, Philadelphia, PA (United States)
- Department of Radiation Oncology, Good Samaritan Cancer Center, Downers Grove, IL (United States)
Purpose: To present guidance for patients and physicians regarding the use of radiotherapy in the treatment of bone metastases according to current published evidence and complemented by expert opinion. Methods and Materials: A systematic search of the National Library of Medicine's PubMed database between 1998 and 2009 yielded 4,287 candidate original research articles potentially applicable to radiotherapy for bone metastases. A Task Force composed of all authors synthesized the published evidence and reached a consensus regarding the recommendations contained herein. Results: The Task Force concluded that external beam radiotherapy continues to be the mainstay for the treatment of pain and/or prevention of the morbidity caused by bone metastases. Various fractionation schedules can provide significant palliation of symptoms and/or prevent the morbidity of bone metastases. The evidence for the safety and efficacy of repeat treatment to previously irradiated areas of peripheral bone metastases for pain was derived from both prospective studies and retrospective data, and it can be safe and effective. The use of stereotactic body radiotherapy holds theoretical promise in the treatment of new or recurrent spine lesions, although the Task Force recommended that its use 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 obviate the need for external beam radiotherapy in appropriate patients. Conclusions: Radiotherapy is a successful and time efficient method by which to palliate pain and/or prevent the morbidity of bone metastases. This Guideline reviews the available data to define its proper use and provide consensus views concerning contemporary controversies or unanswered questions that warrant prospective trial evaluation.
- OSTI ID:
- 21491653
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 79, Issue 4; Other Information: DOI: 10.1016/j.ijrobp.2010.11.026; PII: S0360-3016(10)03577-7; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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