Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota.
Department of Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Pract Radiat Oncol. 2024 Sep-Oct;14(5):377-397. doi: 10.1016/j.prro.2024.04.018. Epub 2024 May 22.
This guideline provides evidence-based recommendations for palliative external beam radiation therapy (RT) in symptomatic bone metastases.
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.
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.
Based on published data, the ASTRO task force's recommendations inform best clinical practices on palliative RT for symptomatic bone metastases.
本指南为症状性骨转移的姑息性外照射放疗（RT）提供了循证推荐意见。
ASTRO 召集了一个工作组，以解决 5 个关于症状性骨转移姑息性 RT 的关键问题。基于卫生保健研究与质量署的系统评价，采用预先确定的共识制定方法建立了建议；还评估了证据质量和推荐强度。
对于症状性骨转移的姑息性 RT，推荐 RT 用于治疗骨转移和脊柱转移引起的疼痛，无论是否伴有脊髓或马尾神经压迫。对于与 RT 相关的其他方法，对于因脊髓或马尾神经压迫导致脊柱转移的患者，手术联合术后 RT 被认为优于单纯 RT。此外，对于伴有脊髓或马尾神经压迫的脊柱转移患者，推荐使用地塞米松。对于需要手术的非脊柱骨转移患者，推荐术后 RT。对于接受常规 RT 治疗的症状性骨转移患者，建议给予 800 cGy 单次分割（800 cGy/1fx）、2000 cGy/5fx、2400 cGy/6fx 或 3000 cGy/10fx。对于不适合手术且接受常规 RT 的脊髓或马尾神经压迫患者，推荐给予 800 cGy/1fx、1600 cGy/2fx、2000 cGy/5fx 或 3000 cGy/10fx。对于无手术或无神经症状/体征且一般状况良好的选择患者，条件推荐立体定向体部 RT 优于常规姑息性 RT。对于接受常规 RT 再照射的脊柱骨转移患者，建议给予 800 cGy/1fx、2000 cGy/5fx、2400 cGy/6fx 或 2000 cGy/8fx；对于接受常规 RT 再照射的非脊柱骨转移患者，建议给予 800 cGy/1fx、2000 cGy/5fx 或 2400 cGy/6fx。确定最佳 RT 方法/方案需要对整个人进行评估，包括预后、以前的 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。此外，为了优化与治疗相关的毒性和生活质量的患者为中心的决策，推荐共同决策。
基于已发表的数据，ASTRO 工作组的建议为症状性骨转移的姑息性 RT 提供了最佳临床实践信息。
