Table 3.
Palliative Radiotherapy for Metastatic Cancer as Delineated in American Society for Therapeutic Radiology and Oncology Treatment Guidelines13,14
| Primary Site and Clinical Circumstances | Recommendations |
|---|---|
| Bone metastases | |
| Uncomplicated, painful bone metastases | • Acceptable fractionation schemes: 30 Gy in 10 fractions, 24 Gy in six fractions, 20 Gy in five fractions, 8 Gy in one fraction |
| Recurrent pain at same skeletal site | • Re-treatment may be attempted, taking into account normal tissue tolerance |
| Multiple painful osteoblastic metastases | • Consider radiopharmaceutical injection |
| Spinal cord compression | • Surgical decompression plus postoperative radiotherapy • Radiotherapy alone in those who do not qualify for or desire surgery |
| Metastases in bones of the spine | • Standard external beam radiotherapy • Stereotactic body radiation therapy may be used, although preferably on a trial |
| Brain metastases | |
| Poor prognosis or performance status | • 20 Gy in five fractions • Supportive care alone |
| Multiple lesions, all < 4 cm in size | • Whole-brain radiotherapy alone • Whole-brain plus radiosurgery • Radiosurgery alone |
| Multiple lesions, any > 4 cm in size | • Whole-brain radiotherapy alone |
| Solitary lesion | • If completely resectable, then surgery plus whole-brain or radiosurgery • If not completely resectable and < 4 cm in size, then radiosurgery alone or with whole-brain radiotherapy • If not completely resectable and > 4 cm in size, then whole-brain radiotherapy alone |