he American Society for Radiation Oncology (ASTRO) published today an updated clinical guideline that details best practices for treating patients who have symptomatic bone metastases and ways to improve their quality of life.
The guideline is available as a free access article in Practical Radiation Oncology, ASTRO’s clinical practice journal.
Many types of cancer can spread to a patient’s skeletal system and trigger new lesions known as bone metastases.
These tumours often cause complications such as pain, broken bones and spinal cord compression.
Existing treatments aim to provide symptom relief, prevent fractures and control further growth of metastatic bone disease. Decades of research show that external beam radiation therapy is a particularly effective treatment for managing symptomatic bone metastases.
“Radiation therapy is a cornerstone of care for patients with symptomatic bone metastases, offering a nonsurgical option for fast pain relief and improved quality of life with minimal side effects,” said Tracy Balboni, MD, MPH, chair of the guideline task force as well as a professor and the clinical director of skeletal (bone/spine) radiation oncology at Harvard Medical School and the Dana-Farber/Brigham and Women’s Cancer Center in Boston. “Our guideline delineates several evidence-based approaches to deliver this tried-and-true therapy, including meaningful improvement from a single treatment session.”
Since ASTRO last updated its guideline in 2017, several large trials demonstrated the benefits of advanced radiation techniques — intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) — to administer a highly targeted, escalated radiation dose for certain patients with bone or spine lesions. Evidence from these clinical trials was included in a systematic review conducted by the Agency for Healthcare Research and Quality (AHRQ) to inform the guideline update.
“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,” said Sara Alcorn, MD, PhD, MPH, vice chair of the guideline task force as well as an associate professor and vice chair of clinical strategy for the department of radiation oncology at the University of Minnesota Medical Center in Minneapolis. “As advanced radiation technologies become more widely accepted, we can increasingly help more patients in fewer treatment sessions and re-treat more patients whose bone metastases return.”
The guideline provides updated evidence on best practices for delivering radiation therapy to unirradiated tumours and in the reirradiation setting. Full recommendations and supporting evidence are provided in the guideline; key recommendations are as follows:
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