Published online Dec 10, 2014. doi: 10.5306/wjco.v5.i5.845
Revised: April 28, 2014
Accepted: July 17, 2014
Published online: December 10, 2014
To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications related to best practice palliative external beam radiotherapy (EBRT) for bone metastases (BM) from lung cancer were sought via literature search (2003-2013). Additional clinical practice guidelines and consensus documents were obtained from the online Standards and Guidelines Evidence Directory. Eligible survey studies contained hypothetical case scenarios which required participants to declare whether or not they would administer palliative EBRT and if so, to specify what dose fractionation schedule they would use. There is no convincing evidence of differential outcomes based on histology or for spine vs non-spine uncomplicated BM. For uncomplicated BM, 8Gy/1 is widely recommended as current best practice; this schedule would be used by up to 39.6% of respondents to treat a painful spinal lesion. Either 8Gy/1 or 20Gy/5 could be considered standard palliative RT for BM-related neuropathic pain; 0%-13.2% would use the former and 5.8%-52.8% of respondents the latter (range 3Gy/1-45Gy/18). A multifraction schedule is the approach of choice for irradiation of impending pathologic fracture or spinal cord compression and 54% would use either 20Gy/5 or 30Gy/10. Survey results regarding management of complicated and uncomplicated BM secondary to lung cancer continue to show a large discrepancy between published literature and patterns of practice.
Core tip: Palliative radiotherapy (PRT) remains the gold standard for treatment of painful bone metastases from lung cancer. While PRT should be appropriately customized to patients, prescription should also be based on robust evidence. Depending on the clinical scenario, between 4%-66% of survey respondents would use dose-fractionation schedules considered congruent with best available current evidence. These results show a large discrepancy between treatment guidelines and international patterns of practice. It is not completely clear why level 1 data supporting specific dose schedules continues to be overlooked, although reasons for reticence in following these recommendations are reviewed.