How should radiation oncologists interpret the ASTRO evidence-based guideline and ASTRO Choosing Wisely campaign for the treatment of uncomplicated bone metastases?

Abstract

In the article accompanying this commentary, Lutz and colleagues provide an updated American Society for Radiation Oncology (ASTRO) evidence-based guideline for palliative radiation therapy (RT) in the treatment of bone metastases. [1] Lutz S Berk L Chang E et al. Palliative radiotherapy for bone metastases: An ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys. 2011; 79: 965-976 Abstract Full Text Full Text PDF PubMed Scopus (655) Google Scholar The latest guideline summarizes important advances regarding the role of retreatment and highly conformal RT. However, the message around single fraction (SF) RT (Key questions 1-3) for uncomplicated bone metastases (UBM) remains unchanged when compared with the 2011 guideline. In brief, SF RT offers a similar rate of pain relief and a toxicity profile to multiple fraction (MF) RT. SF RT is associated with slightly higher rates of retreatment compared with MF RT; 20% versus 8%, as per the cited meta-analysis. [2] Chow E Zeng L Salvo N et al. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol. 2012; 24: 112-124 Abstract Full Text Full Text PDF PubMed Scopus (480) Google Scholar There are data from more than 25 randomized controlled trials (RCTs) and 3 meta-analyses supporting this observation. [1] Lutz S Berk L Chang E et al. Palliative radiotherapy for bone metastases: An ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys. 2011; 79: 965-976 Abstract Full Text Full Text PDF PubMed Scopus (655) Google Scholar The studies on efficacy and toxicity have further been strengthened by economic analyses, which highlight the cost-effectiveness of SF RT 3 Konski A James J Hartsell W et al. Economic analysis of Radiation Therapy Oncology Group (RTOG) 97-14: Multiple versus single fraction radiation treatment of patients with bone metastases. Am J Clin Oncol. 2009; 32: 423 Crossref PubMed Scopus (85) Google Scholar , 4 van den Hout van der Linden YM Steenland E et al. Single-versus multiple-fraction radiotherapy in patients with painful bone metastases: Cost–utility analysis based on a randomized trial. J NCI. 2003; 95: 222-229 Crossref PubMed Scopus (208) Google Scholar ; therefore, there has been a global push to adopt SF RT as an economical and efficacious standard in place of MF RT for UBM. Several guidelines and commentaries have highlighted the benefits of shorter treatment to both patient and society.