Lutz, S., Berk, L., Chang, E., Chow, E., Hahn, C., Hoskin, P., . . . Hartsell, W. (2011). Palliative radiotherapy for bone metastases: An ASTRO evidence-based guideline. International Journal of Radiation Oncology *Biology* Physics, 79, 965–976.
DOI Link
Purpose & Patient Population
PURPOSE: To present guidelines for patients and physicians regarding the use of radiotherapy in the treatment of bone metastases according to the current published evidence and complemented expert opinion
TYPES OF PATIENTS ADDRESSED: Patients with bone metastases
Type of Resource/Evidence-Based Process
RESOURCE TYPE: Evidence-based guideline
PROCESS OF DEVELOPMENT: A task force searched and reviewed evidence from the literature search to address specific questions posed. The task force developed final guidelines via consensus from the evidence.
DATABASES USED: PubMed
KEYWORDS: Radiotherapy, bone metastases
INCLUSION CRITERIA: Not specified
EXCLUSION CRITERIA: Not specified
Phase of Care and Clinical Applications
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Palliative care
Results Provided in the Reference
The literature search yielded 4,287 articles. Of these, the review of evidence included of the sample 25 randomized clinical trials, 20 prospective single-arm studies, and four meta-analyses/systematic reviews. No method of evaluation of study quality was described.
Guidelines & Recommendations
Radiotherapy is a successful and time efficient method to palliate 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.
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Various fractionation schedules can provide significant palliation of symptoms and/or prevent the morbidity of bone metastases.
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Stereotactic body radiation holds theoretical promise in the treatment of new or recurrent spine lesions, and the task force recommended it be limited to highly selected patients, preferably within a prospective trial.
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Surgical decompression and postoperative radiotherapy is recommended for spinal cord compression or spinal instability in highly selected patients with sufficient life expectancy and performance status.
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The use of biophosphonates, 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.
No unacceptable rates of long-term side effects with single fraction therapy were seen. Sites of recurrent pain may be palliated with repeat radiation therapy; however, it was recommended that these patients be treated within an available clinical trial, and care is needed if the field includes the spinal cord due to the risk of myelopathy. The use of radiopharmaceuticals is most appropriate when there are multiple sites of chronic pain. No definitive statement could be made regarding combined external beam radiation therapy and radiopharmaceuticals.
Limitations
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Limited search database
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No stated method of evaluating or grading study quality
Nursing Implications
This systematic review provides information for nurses about evidence regarding use of radiation therapy for the palliation of pain from bone metastases. It points out that use of bone-modifying agents does not preclude use of radiation therapy. It also points out that for patients with multiple sites of disease-related pain, the use of radiopharmaceuticals may be more useful.