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The right way to deliver palliative radiation therapy for pain management

Posted Dec 17 2010 12:00am

It has come to our attention that the American Society for Radiation Oncology (ASTRO) has developed new guidance on the use of palliative external beam radiation therapy (EBRT) for the management of pain associated with metastasis of cancer to bone a relatively common problem in late stage, metastatic prostate cancer.

The complete draft guideline issued by the Guidelines Subcommittee of the Clinical Affairs and Quality Committee of ASTRO is available on the ASTRO web site. In addition, a commentary on the evolution of the new guideline (by the chairman of the guideline task force) is available on the web site of Oncology News International.

The fundamental issue was whether palliative radiation therapy to relieve pain cause by boney metastases can or should be given in a single dose or in fractionated doses. The task force has clearly come down on the side of single dose radiation for palliative care. To quote Dr. Lutz, the chairman of the task force:

… prospective randomized trials demonstrate that single-fraction EBRT provides equivalent pain control with similar or fewer side effects. If pain recurs, a single 8-Gy fraction can be safely and effectively repeated, according to the guideline. An added advantage of single-fraction treatment is its increased efficiency.

Additional information about this specific topic is available in the links provided.

The task force did note that stereotactic body radiotherapy (SBRT) holds “theoretical” promise as a treatment for new or recurrent spine lesions, but recommended that its use be limited to highly selected patients at centers familiar with the dosing and risks of SBRT and, preferably, on a prospective trial.

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