External beam radiotherapy and bone metastases

Management of bone metastasis is a multi-disciplinary effort that involves coordination between several medical specialties. External beam radiation therapy (EBRT) remains a powerful and efficient method of palliating pain and preventing skeletal complications from osseous metastasis. Various fractionation schemes, ranging from 8 Gy in a single dose to 30 Gy in 10 fractions, provide equivalent pain relief as demonstrated by dozens of randomized clinical trials. Toxicity profiles are well established and the treatment is generally well tolerated. Radiopharmaceuticals and high-dose, stereotactic radiation therapy are adjuncts to EBRT whose role is being elucidated through clinical trials. Multiple organizations have compiled guidelines and quality metrics to help refine the role of each modality in the management of painful osseous metastases.