When do you prescribe steroids prior to palliative radiotherapy of bone metastases to prevent pain flare?   

The Canadian study presented at ASTRO 2015 showed a decrease in pain flare prior to single dose 8Gy RT, but steroids were given for 5 days prior to RT. We often treat less then 5 days after seeing a patient in this situation.  Is this something that should be done routinely for painful mets treated with a single fraction? SBRT? What duration and dose of dexamethasone is appropriate?



Answer from: Radiation Oncologist at Academic Institution