Do you ever prophylactically treat an asymptomatic bone metastasis to prevent or delay risk of pathologic fracture?

Yes, this is a situation I have encountered before and I think it is very reasonable to deliver prophylactic RT if there is cortical thinning indicating fracture risk, or if there is documented growth of the metastatic lesion, even in the absence of any symptoms to palliate.

Another situation in wh...

Managing a bone metastasis with palliative RT to prevent fracture has been a longstanding indication for treatment. Much of the literature states this. However, none of the literature points to a reference that shows that RT prevents fractures.

We understand that RT can change bone remodeling. We kn...

Yes. One of the highlighted presentations at ASTRO 2022 (Dr. @Dr. First Last et al) was a randomized trial of early elective RT of asymptomatic bone lesions, vs. RT when they became symptomatic, from MSKCC. It was strongly positive in that the early RT reduced subsequent skeletal events and hospital...

Yes.

My standard practice is, for any weight bearing bone at risk of pathological fracture, to refer immediately to an orthopedic surgeon for pinning/rodding.