What is your preferred palliative radiation regimen for patients with painful bone metastasis?

Because of the great work of the BM Working Group led by Hartsell et al, and the Dutch, for examples, there are ample category 1 data supporting the use of Single Fraction (800cGyx1) EBRT for "uncomplicated" bone lesions. That is, the use of 800cGy x1 unless there is: a soft tissue component, an impending fracture, a large lytic lesion in a weight bearing bone, post-operative pinning or spinal cord compression.

So, as to your question, I would incorporate these clinical factors into my thought process, along with what you noted.

However, when life expectancy is less than 30 to 60 days or so, a shorter fractionation can be useful depending on the travel circumstances and the like. Otherwise, in those instances listed above - the typical dose o...