C M Rose1, A R Kagan. 1. St. Joseph Medical Center, Los Angeles, CA, USA.
Abstract
BACKGROUND: In the United States, at least half of the patients who are irradiated are done so with palliative intent. The most common presentation is the patient with bone metastasis. However, because current scientific outcome and technology techniques are insufficient for the creation of guidelines, the American College of Radiology created a work group of experts to formulate appropriateness criteria for the irradiation of bone metastasis. METHOD: A MEDLINE search to help review the community practices was initiated. Twenty-five clinical vignettes were reviewed by a panel of experts. Recommendations for each vignette were prioritized and selected based on choices proposed by panel members. RESULT: Doses in the range of 20 Gy in 5 fractions, 30 Gy in 10 fractions, or 35 Gy in 14 fractions are acceptable in most circumstances. Daily doses > 4.0 Gy were not commonly suggested. CIRCUMSTANCES: To determine optimal dose fractionation schemes, more emphasis needs to be put on the life expectancy of the patients. Rapid schedules are acceptable in patients with short life expectancy (i.e., < 3 months), but this hypothesis needs to be tested. Further research to better define the clinical indications of hemibody irradiation and strontium-89 is recommended.
BACKGROUND: In the United States, at least half of the patients who are irradiated are done so with palliative intent. The most common presentation is the patient with bone metastasis. However, because current scientific outcome and technology techniques are insufficient for the creation of guidelines, the American College of Radiology created a work group of experts to formulate appropriateness criteria for the irradiation of bone metastasis. METHOD: A MEDLINE search to help review the community practices was initiated. Twenty-five clinical vignettes were reviewed by a panel of experts. Recommendations for each vignette were prioritized and selected based on choices proposed by panel members. RESULT: Doses in the range of 20 Gy in 5 fractions, 30 Gy in 10 fractions, or 35 Gy in 14 fractions are acceptable in most circumstances. Daily doses > 4.0 Gy were not commonly suggested. CIRCUMSTANCES: To determine optimal dose fractionation schemes, more emphasis needs to be put on the life expectancy of the patients. Rapid schedules are acceptable in patients with short life expectancy (i.e., < 3 months), but this hypothesis needs to be tested. Further research to better define the clinical indications of hemibody irradiation and strontium-89 is recommended.
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