THE FINAL REPORT OF THE EXPERT PANEL FOR THE RADIATION ONCOLOGY BONE METASTASIS WORK GROUP OF THE AMERICAN-COLLEGE OF RADIOLOGY

Background: In the United States, at least half of the patients who ar e irradiated are done so with palliative intent. The most common prese ntation is the patient with bone metastasis. However, because current scientific outcome and technology techniques are insufficient for the creation of guidelines, the American College of Radiology created a wo rk group of experts to formulate appropriateness criteria for the irra diation of bone metastasis. Method: A MEDLINE search to help review th e community practices was initiated. Twenty-five clinical vignettes we re reviewed by a panel of experts. Recommendations for each vignette w ere prioritized and selected based on choices proposed by panel member s. Result: Doses in the range of 20 Gy in 5 fractions, 30 Gy in 10 fra ctions, or 35 Gy in 14 fractions are acceptable in most circumstances. Daily doses > 4.0 Gy were not commonly suggested. Circumstances: To d etermine optimal dose fractionation schemes, more emphasis needs to be put on the life expectancy of the patients. Rapid schedules are accep table in patients with short life expectancy (i.e., <3 months), but th is hypothesis needs to be tested. Further research to better define th e clinical indications of hemibody irradiation and strontium-89 is rec ommended. (C) 1998 Elsevier Science Inc.