title: Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline.
abstract: OBJECTIVE
  To present guidance for patients and physicians regarding the use of radiotherapy in the treatment of bone metastases according to current published evidence and complemented by expert opinion.
  
  
  METHODS
  A systematic search of the National Library of Medicine's PubMed database between 1998 and 2009 yielded 4,287 candidate original research articles potentially applicable to radiotherapy for bone metastases. A Task Force composed of all authors synthesized the published evidence and reached a consensus regarding the recommendations contained herein.
  
  
  RESULTS
  The Task Force concluded that external beam radiotherapy continues to be the mainstay for the treatment of pain and/or prevention of the morbidity caused by bone metastases. Various fractionation schedules can provide significant palliation of symptoms and/or prevent the morbidity of bone metastases. The evidence for the safety and efficacy of repeat treatment to previously irradiated areas of peripheral bone metastases for pain was derived from both prospective studies and retrospective data, and it can be safe and effective. The use of stereotactic body radiotherapy holds theoretical promise in the treatment of new or recurrent spine lesions, although the Task Force recommended that its use be limited to highly selected patients and preferably within a prospective trial. Surgical decompression and postoperative radiotherapy is recommended for spinal cord compression or spinal instability in highly selected patients with sufficient performance status and life expectancy. The use of bisphosphonates, radionuclides, vertebroplasty, and kyphoplasty for the treatment or prevention of cancer-related symptoms does not obviate the need for external beam radiotherapy in appropriate patients.
  
  
  CONCLUSIONS
  Radiotherapy is a successful and time efficient method by which to palliate pain and/or prevent the morbidity of bone metastases. This Guideline reviews the available data to define its proper use and provide consensus views concerning contemporary controversies or unanswered questions that warrant prospective trial evaluation.
authors.affiliation: Department of Radiation Oncology, Blanchard Valley Regional Cancer Center, Findlay, OH 45840, USA. slutz@bvha.org
authors.forename: Stephen
authors.initials: S
authors.lastname: Lutz
authors.forename: Lawrence
authors.initials: L
authors.lastname: Berk
authors.forename: Eric
authors.initials: E
authors.lastname: Chang
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
authors.forename: Carol
authors.initials: C
authors.lastname: Hahn
authors.forename: Peter
authors.initials: P
authors.lastname: Hoskin
authors.forename: David
authors.initials: D
authors.lastname: Howell
authors.forename: Andre
authors.initials: A
authors.lastname: Konski
authors.forename: Lisa
authors.initials: L
authors.lastname: Kachnic
authors.forename: Simon
authors.initials: S
authors.lastname: Lo
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.forename: Larry
authors.initials: L
authors.lastname: Silverman
authors.forename: Charles
authors.initials: C
authors.lastname: von Gunten
authors.forename: Ehud
authors.initials: E
authors.lastname: Mendel
authors.forename: Andrew
authors.initials: A
authors.lastname: Vassil
authors.forename: Deborah Watkins
authors.initials: DW
authors.lastname: Bruner
authors.forename: William
authors.initials: W
authors.lastname: Hartsell
mesh_terms: D001847:Bone Diseases / Q000532:radiotherapy / Q000601:surgery; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D006801:Humans; D010146:Pain / Q000532:radiotherapy / Q000601:surgery; D016634:Radiosurgery; D012955:Societies, Medical; D013117:Spinal Cord Compression / Q000532:radiotherapy / Q000601:surgery; D014481:United States