Recent important developments in the management of nonspine bone metastases

External-beam radiotherapy (EBRT) remains the most important treatment for patients with painful bone metastases. This review updates the recent information regarding therapeutic guidelines, pain flare reaction, treatment endpoints, and quality-of-life (QOL) measurements.

Firstly, within the framework of the Third International Consensus Conference Workshop on Palliative Radiotherapy, the American Society for Radiation Oncology has published evidence-based treatment guidelines for bone metastases which should be employed in evaluating both the care of individuals as well as the quality indices of radiotherapy centers. Secondly, the definition and proper management of pain flare following the initiation of radiotherapy for bone metastases allows for the prevention or minimization of this treatment-related phenomenon. Thirdly, the appropriate endpoints for treatment response have been updated and should be employed for all clinical trials measuring clinical efficacy. Finally, the EORTC QLQ-BM22 QOL module has been validated and should be used to measure QOL in all patients entered onto trials.

Although the treatment of bone metastases with EBRT is a well established method for providing palliative relief from painful bone metastases, recent publications have enhanced our knowledge of the best approaches to caring for this clinical scenario.