ASTRO Publishes Guidelines for Palliative Radiotherapy for Bone Metastases

The American Society for Radiation Oncology (ASTRO) has released guidelines for the use of radiation therapy in treating bone metastases; the guidelines are now published here in the International Journal of Radiation Oncology•Biology•Physics.

Osteoplastic Metastasis of Prostate Cancer in Choline PET/CT

ASTRO states that external beam radiation therapy (EBRT) continues to be the mainstay of treatment for bone metastases, however, the widespread variation in practice patterns has created a need for formal treatment guidelines.

Highlights from the guidelines:

1. Single doses and longer courses of radiation have shown similar pain relief outcomes, and each has advantages. A single course has proven more convenient for patients and caregivers, while longer courses have a lower incidence of repeat treatment to the same site.

2. Repeat irradiation with EBRT might be feasible in some circumstances, though effectiveness and safety are still to be determined.

3. Bisphosphonates do not eliminate the need for EBRT for painful metastases, and they act effectively when combined with EBRT.

4. Stereotactic body radiation therapy can be considered for patients with a newly discovered or recurrent tumor in the spinal column or paraspinal areas; however, stereotactic treatment should 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.

5. Radionuclides are most appropriate for patients who have several sites of painful osteoblastic metastases (like those that are commonly associated with prostate cancer) that cannot be safely treated with EBRT.

6. Surgical decompression and stabilization plus postoperative radiation therapy should be considered for some patients with single-level spinal cord compression or spinal instability.