External Beam Radiation Therapy for Palliation of Symptomatic Bone Metastases: An ASTRO Clinical Practice Guideline

IF 3.4 3区医学 Q2 ONCOLOGY Practical Radiation Oncology Pub Date : 2024-09-01 DOI:10.1016/j.prro.2024.04.018

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Abstract

Purpose

This guideline provides evidence-based recommendations for palliative external beam radiation therapy (RT) in symptomatic bone metastases.

Methods

The ASTRO convened a task force to address 5 key questions regarding palliative RT in symptomatic bone metastases. Based on a systematic review by the Agency for Health Research and Quality, recommendations using predefined consensus-building methodology were established; evidence quality and recommendation strength were also assessed.

Results

For palliative RT for symptomatic bone metastases, RT is recommended for managing pain from bone metastases and spine metastases with or without spinal cord or cauda equina compression. Regarding other modalities with RT, for patients with spine metastases causing spinal cord or cauda equina compression, surgery and postoperative RT are conditionally recommended over RT alone. Furthermore, dexamethasone is recommended for spine metastases with spinal cord or cauda equina compression. Patients with nonspine bone metastases requiring surgery are recommended postoperative RT. Symptomatic bone metastases treated with conventional RT are recommended 800 cGy in 1 fraction (800 cGy/1 fx), 2000 cGy/5 fx, 2400 cGy/6 fx, or 3000 cGy/10 fx. Spinal cord or cauda equina compression in patients who are ineligible for surgery and receiving conventional RT are recommended 800 cGy/1 fx, 1600 cGy/2 fx, 2000 cGy/5 fx, or 3000 cGy/10 fx. Symptomatic bone metastases in selected patients with good performance status without surgery or neurologic symptoms/signs are conditionally recommended stereotactic body RT over conventional palliative RT. Spine bone metastases reirradiated with conventional RT are recommended 800 cGy/1 fx, 2000 cGy/5 fx, 2400 cGy/6 fx, or 2000 cGy/8 fx; nonspine bone metastases reirradiated with conventional RT are recommended 800 cGy/1 fx, 2000 cGy/5 fx, or 2400 cGy/6 fx. Determination of an optimal RT approach/regimen requires whole person assessment, including prognosis, previous RT dose if applicable, risks to normal tissues, quality of life, cost implications, and patient goals and values. Relatedly, for patient-centered optimization of treatment-related toxicities and quality of life, shared decision making is recommended.

Conclusions

Based on published data, the ASTRO task force's recommendations inform best clinical practices on palliative RT for symptomatic bone metastases.

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用于缓解症状性骨转移的体外放射治疗：ASTRO临床实践指南》。

目的：本指南为无症状骨转移的姑息性体外放射治疗（RT）提供循证建议：美国放射肿瘤学会（ASTRO）召集了一个特别工作组，以解决有关无症状骨转移姑息性 RT 的 5 个关键问题。根据卫生研究与质量局的系统审查，采用预定义的建立共识方法确定了建议；同时还评估了证据质量和建议力度：结果：对于无症状骨转移的姑息性 RT，推荐采用 RT 来控制骨转移和脊柱转移引起的疼痛，无论是否存在脊髓或马尾受压。至于与 RT 配合使用的其他方式，对于脊柱转移导致脊髓或马尾受压的患者，有条件地推荐手术和术后 RT，而非单纯 RT。此外，对于脊柱转移导致脊髓或马尾受压的患者，建议使用地塞米松。需要手术的非脊柱骨转移患者建议术后 RT。采用常规 RT 治疗的无症状骨转移瘤建议采用 800 cGy 分 1 次放疗（800 cGy/1fx）、2000 cGy/5fx、2400 cGy/6fx 或 3000 cGy/10fx。脊髓或马尾受压患者如不符合手术条件且正在接受常规 RT，建议使用 800 cGy/1fx、1600 cGy/2fx、2000 cGy/5fx 或 3000 cGy/10fx。对于表现良好、未接受手术或出现神经系统症状/体征的有症状骨转移患者，有条件地推荐使用 SBRT，而非传统的姑息性 RT。脊柱骨转移瘤再照射常规 RT 时，推荐使用 800cGy/1fx、2000cGy/5fx、2400cGy/6fx 或 2000cGy/8fx；非脊柱骨转移瘤再照射常规 RT 时，推荐使用 800cGy/1fx、2000cGy/5fx 或 2400cGy/6fx。确定最佳 RT 方法/方案需要对患者进行全面评估，包括预后、先前的 RT 剂量（如果适用）、对正常组织的风险、生活质量、成本影响以及患者的目标和价值观。与此相关，为了以患者为中心优化治疗相关毒性和生活质量，建议共同决策：根据已发表的数据，ASTRO 工作组的建议为姑息性 RT 治疗无症状骨转移的最佳临床实践提供了参考。

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来源期刊

Practical Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

5.20

自引率

6.10%

发文量

177

审稿时长

34 days

期刊介绍： The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes: Original articles focusing on patient safety, quality measurement, or quality improvement initiatives Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues ASTRO guidelines, position papers, and consensus statements Essays that highlight enriching personal experiences in caring for cancer patients and their families.