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Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline.

Publication ,  Journal Article
Lutz, S; Balboni, T; Jones, J; Lo, S; Petit, J; Rich, SE; Wong, R; Hahn, C
Published in: Pract Radiat Oncol
2017

PURPOSE: The purpose is to provide an update the Bone Metastases Guideline published in 2011 based on evidence complemented by expert opinion. The update will discuss new high-quality literature for the 8 key questions from the original guideline and implications for practice. METHODS AND MATERIALS: A systematic PubMed search from the last date included in the original Guideline yielded 414 relevant articles. Ultimately, 20 randomized controlled trials, 32 prospective nonrandomized studies, and 4 meta-analyses/pooled analyses were selected and abstracted into evidence tables. The authors synthesized the evidence and reached consensus on the included recommendations. RESULTS: Available literature continues to support pain relief equivalency between single and multiple fraction regimens for bone metastases. High-quality data confirm single fraction radiation therapy may be delivered to spine lesions with acceptable late toxicity. One prospective, randomized trial confirms both peripheral and spine-based painful metastases can be successfully and safely palliated with retreatment for recurrence pain with adherence to published dosing constraints. Advanced radiation therapy techniques such as stereotactic body radiation therapy lack high-quality data, leading the panel to favor its use on a clinical trial or when results will be collected in a registry. The panel's conclusion remains that surgery, radionuclides, bisphosphonates, and kyphoplasty/vertebroplasty do not obviate the need for external beam radiation therapy. CONCLUSION: Updated data analysis confirms that radiation therapy provides excellent palliation for painful bone metastases and that retreatment is safe and effective. Although adherence to evidence-based medicine is critical, thorough expert radiation oncology physician judgment and discretion regarding number of fractions and advanced techniques are also essential to optimize outcomes when considering the patient's overall health, life expectancy, comorbidities, tumor biology, anatomy, previous treatment including prior radiation at or near current site of treatment, tumor and normal tissue response history to local and systemic therapies, and other factors related to the patient, tumor characteristics, or treatment.

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Published In

Pract Radiat Oncol

DOI

EISSN

1879-8519

Publication Date

2017

Volume

7

Issue

1

Start / End Page

4 / 12

Location

United States

Related Subject Headings

  • Vertebroplasty
  • Radiopharmaceuticals
  • PubMed
  • Practice Guidelines as Topic
  • Palliative Care
  • Kyphoplasty
  • Humans
  • Evidence-Based Medicine
  • Diphosphonates
  • Bone Neoplasms
 

Citation

APA
Chicago
ICMJE
MLA
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Lutz, S., Balboni, T., Jones, J., Lo, S., Petit, J., Rich, S. E., … Hahn, C. (2017). Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol, 7(1), 4–12. https://doi.org/10.1016/j.prro.2016.08.001
Lutz, Stephen, Tracy Balboni, Joshua Jones, Simon Lo, Joshua Petit, Shayna E. Rich, Rebecca Wong, and Carol Hahn. “Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline.Pract Radiat Oncol 7, no. 1 (2017): 4–12. https://doi.org/10.1016/j.prro.2016.08.001.
Lutz S, Balboni T, Jones J, Lo S, Petit J, Rich SE, et al. Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol. 2017;7(1):4–12.
Lutz, Stephen, et al. “Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline.Pract Radiat Oncol, vol. 7, no. 1, 2017, pp. 4–12. Pubmed, doi:10.1016/j.prro.2016.08.001.
Lutz S, Balboni T, Jones J, Lo S, Petit J, Rich SE, Wong R, Hahn C. Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol. 2017;7(1):4–12.
Journal cover image

Published In

Pract Radiat Oncol

DOI

EISSN

1879-8519

Publication Date

2017

Volume

7

Issue

1

Start / End Page

4 / 12

Location

United States

Related Subject Headings

  • Vertebroplasty
  • Radiopharmaceuticals
  • PubMed
  • Practice Guidelines as Topic
  • Palliative Care
  • Kyphoplasty
  • Humans
  • Evidence-Based Medicine
  • Diphosphonates
  • Bone Neoplasms