Would you utilize single fraction palliative radiation therapy for a large bone metastasis?

The issue of field size was addressed in an early RTOG study (RTOG 78-10) where they looked at half-body RT. It was extremely effective with 73% partial or complete response and fast-acting, with 50% of patients experiencing relief within 48 hours. (Salazar et al., PMID 2423225). Patients could be radiated to the upper half, the mid-portion, or the lower half. 6 Gy was the best dose for the upper half body (lungs) and 8 Gy for the lower. (See paper for additional details). This treatment was ext...

In the modern era of oncology, there have been significant advances in systemic therapy improving survival (chemotherapy, targeted therapy, and immunotherapy) thus changing the landscape of treatment paradigms for patients with metastatic disease. We have moved towards an individualized multidisciplinary treatment approach for patients based on disease burden and life expectancy (oligometastatic vs multiple metastases with response to systemic therapy vs palliative progressive refractory to syst...