Palliative radiotherapy for bone metastases: conventional external beam radiotherapy

Area of Science:

• Oncology
• Radiation Oncology
• Palliative Care

Background:

• Conventional external beam radiotherapy (cEBRT) remains a key treatment for symptomatic bone metastases.
• Despite advancements like stereotactic body radiotherapy, cEBRT demand persists.
• This review focuses on cEBRT strategies for bone metastases management.

Purpose of the Study:

• To review current applications of cEBRT for bone metastases.
• To discuss initial palliative radiotherapy, reirradiation, and treatment for spinal complications.
• To highlight evidence-based recommendations for managing bone metastases with cEBRT.

Main Methods:

• Review of randomized controlled trials and meta-analyses on cEBRT for bone metastases.
• Analysis of data regarding single-fraction versus multifractionated cEBRT efficacy.
• Evaluation of treatment strategies for metastatic spinal cord compression and instability.

Main Results:

• Single-fraction 8 Gy cEBRT is as effective as multifractionated cEBRT for pain relief.
• Efficacy of radiotherapy in preventing skeletal-related events requires further research.
• Prophylactic fixation is recommended for high-risk long-bone metastases; reirradiation is indicated for pain progression.

Conclusions:

• Single-fraction 8 Gy cEBRT is a viable palliative option for bone metastases pain.
• Careful consideration of spinal cord tolerance is essential for palliative reirradiation of spinal metastases.
• Multidisciplinary decision-making is vital for managing metastatic spinal cord compression and instability, often involving surgery and radiotherapy.