ASTRO publishes guideline on palliative RT for bone metastases

External beam radiation therapy (EBRT) remains the mainstay for treating bone metastases, according to a new American Society for Radiation Oncology guideline for the use of radiation therapy in treating bone metastases.

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The guideline, developed by ASTRO’s Oncology Clinical Affairs and Quality Committee, was published online in the International Journal of Radiation Oncology Biology Physics (Jan. 27, 2011).

"Radiation therapy is commonly used to treat bone metastases and has been proven very effective, but with the variety of radiation therapies available and range of successful fractionation schedules, it’s important to provide physicians with this guideline to assure they are using the most appropriate methods in treating patients," said lead author Stephen Lutz, MD, of Blanchard Valley Regional Cancer Center, Findlay, OH.

Some of the committee’s findings include:

• Both single doses and longer courses of radiation have shown similar pain relief outcomes, and each has advantages.
• Radionuclides are most appropriate for patients who have several sites of painful osteoblastic metastases (such as those that are commonly associated with prostate cancer) that cannot be conveniently or safely treated with EBRT.
• Bisphosphonates do not eliminate the need for EBRT for painful metastases, and they act effectively when combined with EBRT.
• Repeat irradiation with EBRT might be feasible in some circumstances, although the details of its effectiveness and safety are still to be determined.
• Stereotactic body radiation therapy can be considered in patients with a newly discovered or recurrent tumor in the spinal column or paraspinal areas; however, it is suggested that stereotactic treatment be reserved for patients who meet specific criteria, who are treated at centers with sufficient training and experience, and who are part of a therapeutic trial.
• Surgical decompression and stabilization plus postoperative radiation therapy should be considered for some patients with single-level spinal cord compression or spinal instability.