Single-fraction RT may close
treatment gap
treatment gap
ASTRO updates guideline on palliative radiation therapy for bone metastases
February 14, 2017
by Lauren Dubinsky, Senior Reporter
The American Society for Radiation Oncology has updated its clinical guideline for palliative radiation therapy to treat painful bone metastases.
The guideline maintains the dosing schedules that were previously recommended for external RT to treat tumors that haven't received radiation. Those include a single 8 Gy fraction of RT, 20 Gy administered in five fractions, 24 Gy in six fractions or 30 Gy in 10 fractions.
A study published in the Journal of Clinical Oncology in 2004 found that 88 percent of hospice professionals reported that painful bone metastases should be referred for palliative RT, but only 3 percent of patients in the U.S. actually received treatment.
High cost, lack of transportation and length of treatment were cited as the main hurdles to care. Many times, patients are unable to travel to the facility for five to 10 fractions of palliative RT.
Since single-fraction RT only requires one visit, it's a better option for those patients. ASTRO believes that greater adoption of this approach may reduce the disparity between the number of patients who would benefit from the therapy and those who receive it.
Clinical trials have shown that the rate of pretreatment is higher among patients who receive single-fraction RT, but the convenience of it may make it the best option for patients with limited life expectancy.
An analysis of clinical trial data published in JAMA Oncology this month found that a single 8 Gy radiotherapy dose for bone metastases should be offered to all patients including those with poor survival.
The updated guideline — based on a systematic literature review of 56 studies published from December 2009 to January 2015 — also includes recommendations for the pretreatment of bone metastases. If patients experience recurrent pain more than a month after external-beam radiation therapy then re-irradiation is recommended.
The role of advanced RT techniques including stereotactic body RT was also addressed in the guideline. It's recommended that SBRT should only be used in clinical trial or registry settings because of the lack of data supporting its use for treating spinal metastases.
The complete guideline, Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline, is available as a free access article in ASTRO's clinical practice journal, Practical Radiation Oncology.
The guideline maintains the dosing schedules that were previously recommended for external RT to treat tumors that haven't received radiation. Those include a single 8 Gy fraction of RT, 20 Gy administered in five fractions, 24 Gy in six fractions or 30 Gy in 10 fractions.
A study published in the Journal of Clinical Oncology in 2004 found that 88 percent of hospice professionals reported that painful bone metastases should be referred for palliative RT, but only 3 percent of patients in the U.S. actually received treatment.
High cost, lack of transportation and length of treatment were cited as the main hurdles to care. Many times, patients are unable to travel to the facility for five to 10 fractions of palliative RT.
Since single-fraction RT only requires one visit, it's a better option for those patients. ASTRO believes that greater adoption of this approach may reduce the disparity between the number of patients who would benefit from the therapy and those who receive it.
Clinical trials have shown that the rate of pretreatment is higher among patients who receive single-fraction RT, but the convenience of it may make it the best option for patients with limited life expectancy.
An analysis of clinical trial data published in JAMA Oncology this month found that a single 8 Gy radiotherapy dose for bone metastases should be offered to all patients including those with poor survival.
The updated guideline — based on a systematic literature review of 56 studies published from December 2009 to January 2015 — also includes recommendations for the pretreatment of bone metastases. If patients experience recurrent pain more than a month after external-beam radiation therapy then re-irradiation is recommended.
The role of advanced RT techniques including stereotactic body RT was also addressed in the guideline. It's recommended that SBRT should only be used in clinical trial or registry settings because of the lack of data supporting its use for treating spinal metastases.
The complete guideline, Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline, is available as a free access article in ASTRO's clinical practice journal, Practical Radiation Oncology.