Would you offer 12-16 Gy in a single fraction for a symptomatic, non-vertebral bone metastasis?

Yes.

We have randomized, prospective studies indicating that dose-escalation with 1-2 fractions improves control of pain over conventional RT doses - here and here. We also have a meta-analysis showing higher chance of complete response of pain with SBRT. In addition, the Canadian investigators showed it was cost-effective compared with standard of care.

It is:

1. Better
2. Faster
3. Possibly cheaper (if done in 1-2 fractions)

ASTRO made the right call based on available evidence. Hopefully, payors will ag...

Yes, provided that the patient has a reasonable prognosis and the pain is manageable and they can wait a few extra days for planning. The 12 Gy group didn't do any better than conventional so I try to do 16 Gy even for larger mets and SIB the GTV to 18 Gy. Usually not a problem meeting OAR constraints for non VB mets.