Recommendations issued for palliative radiation therapy for symptomatic bone metastases

In a clinical practice guideline issued by the American Society for Radiation Oncology and published in Practical Radiation Oncology, evidence-based recommendations are presented for the use of palliative external beam radiation therapy (RT) for symptomatic bone metastases.

Sarah Alcorn, M.D., Ph.D., M.P.H., from the University of Minnesota in Minneapolis, and colleagues developed evidence-based recommendations for palliative external beam RT in symptomatic bone metastases. Five key questions regarding palliative RT were addressed.

The authors noted that RT is recommended for managing pain from bone metastases and spine metastases with or without spinal cord or cauda equina compression for palliative RT. Regarding other RT modalities, surgery and postoperative RT are conditionally recommended over RT alone for patients with spine metastases causing spinal cord or cauda equina compression. For spine metastases with spinal cord or cauda equina compression, dexamethasone is recommended. Postoperative RT is recommended for patients with nonspine bone metastases requiring surgery.

For symptomatic bone metastases, conventional RT is recommended in 800 cGy in one fraction (800 cGy/1fx), 2,000 cGy/5fx, 2,400 cGy/6fx, or 3,000 cGy/10fx. In patients ineligible for surgery and receiving conventional RT for spinal cord or cauda equina compression, 800 cGy/1fx, 1,600 cGy/2fx, 2,000 cGy/5fx, or 3,000 cGy/10fx are recommended. In selected patients with good performance status without surgery or neurological symptoms/signs with symptomatic bone metastases, stereotactic body RT is conditionally recommended over conventional palliative RT. Whole-person assessment is necessary for determination of an optimal RT approach/regimen.

“The use of conformal radiation and dose escalation for symptomatic bone metastases has moved from the experimental domain toward routine clinical care for many patients,” Alcorn said in a statement.