Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline
Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline
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DOI：
10.1016/j.prro.2016.08.001
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发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
Hahn, Carol
中科院分区：
文献类型：
--
作者：
Lutz, Stephen;Balboni, Tracy;Hahn, Carol
目的：提供2011年发布的骨转移指南的最新版本，该指南以证据为基础，辅以专家意见。此次更新将讨论关于原指南中8个关键问题的新的高质量文献及其对实践的影响。方法和材料：对原始指南中最后一次纳入的PubMed进行系统检索，得到414篇相关文章。最终，20个随机对照试验、32个前瞻性非随机研究和4个荟萃分析/汇集分析被选入证据表。作者综合了证据，并就纳入的建议达成了共识。结果：现有文献继续支持单分割方案和多分割方案在骨转移瘤止痛方面的等效性。高质量的数据证实，单次分割放射治疗可用于晚期毒性可接受的脊柱病变。一项前瞻性的随机试验证实，在遵守已公布的剂量限制的情况下，通过对复发疼痛的再治疗，可以成功和安全地缓解外周和脊柱转移的疼痛。立体定向身体放射治疗等先进的放射治疗技术缺乏高质量的数据，导致专家小组倾向于在临床试验中使用这种技术，或者当结果将被收集到注册中心时使用。专家小组的结论仍然是，手术、放射性核素、双磷酸盐和后凸成形术/椎体成形术并不能消除体外放射治疗的需要。结论：最新的数据分析证实，放射治疗对骨转移癌疼痛提供了极好的姑息治疗，再治疗是安全和有效的。尽管坚持循证医学是至关重要的，但在考虑患者的整体健康、预期寿命、合并症、肿瘤生物学、解剖学、既往治疗(包括当前治疗地点或附近的既往放射治疗)、肿瘤和正常组织对局部和系统治疗的反应史以及其他与患者、肿瘤特征或治疗相关的因素时，彻底的放射肿瘤学医生对分割数量和先进技术的判断和裁量对于优化结果也是至关重要的。(C)2016年美国放射肿瘤学学会。爱思唯尔公司出版，版权所有。
Purpose: The purpose is to provide an update the Bone Metastases Guideline published in 2011 based on evidence complemented by expert opinion. The update will discuss new high-quality literature for the 8 key questions from the original guideline and implications for practice.Methods and materials: A systematic PubMed search from the last date included in the original Guideline yielded 414 relevant articles. Ultimately, 20 randomized controlled trials, 32 prospective nonrandomized studies, and 4meta-analyses/pooled analyses were selected and abstracted into evidence tables. The authors synthesized the evidence and reached consensus on the included recommendations.Results: Available literature continues to support pain relief equivalency between single and multiple fraction regimens for bone metastases. High-quality data confirmsingle fraction radiation therapy may be delivered to spine lesions with acceptable late toxicity. One prospective, randomized trial confirms both peripheral and spine-based painful metastases can be successfully and safely palliated with retreatment for recurrence pain with adherence to published dosing constraints. Advanced radiation therapy techniques such as stereotactic body radiation therapy lack high-quality data, leading the panel to favor its use on a clinical trial or when results will be collected in a registry. The panel's conclusion remains that surgery, radionuclides, bisphosphonates, and kyphoplasty/vertebroplasty do not obviate the need for external beam radiation therapy.Conclusion: Updated data analysis confirms that radiation therapy provides excellent palliation for painful bone metastases and that retreatment is safe and effective. Although adherence to evidence-based medicine is critical, thorough expert radiation oncology physician judgment and discretion regarding number of fractions and advanced techniques are also essential to optimize outcomes when considering the patient's overall health, life expectancy, comorbidities, tumor biology, anatomy, previous treatment including prior radiation at or near current site of treatment, tumor and normal tissue response history to local and systemic therapies, and other factors related to the patient, tumor characteristics, or treatment. (C) 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.