本指南为有症状骨转移的姑息性外放射治疗 (RT) 提供循证建议。美国放射肿瘤学会 (ASTRO) 召集了一个工作组来解决有关有症状骨转移姑息性放疗的 5 个关键问题。根据卫生研究和质量局的系统审查，使用预先确定的建立共识方法提出了建议；还评估了证据质量和推荐强度。对于有症状骨转移的姑息性放疗，建议放疗用于控制骨转移和脊柱转移（伴或不伴脊髓或马尾受压）引起的疼痛。关于其他放疗方式，对于脊柱转移瘤导致脊髓或马尾受压的患者，有条件地建议手术和术后放疗，而不是单独放疗。此外，建议使用地塞米松治疗脊髓或马尾受压的脊柱转移瘤。对于需要手术的非脊柱骨转移患者，建议术后进行放疗。对于采用常规放疗治疗的有症状骨转移瘤，建议采用 1 次 800 cGy (800 cGy/1fx)、2000 cGy/5fx、2400 cGy/6fx 或 3000 cGy/10fx。对于不适合手术并接受常规放疗的患者，建议脊髓或马尾压迫 800 cGy/1fx、1600 cGy/2fx、2000 cGy/5fx 或 3000 cGy/10fx。对于有症状的骨转移患者，如果其体力状态良好，无需手术或没有神经系统症状/体征，则有条件地建议进行 SBRT，而不是传统的姑息性放疗。脊柱骨转移瘤采用常规放疗重新照射，建议剂量为 800 cGy/1fx、2000 cGy/5fx、2400 cGy/6fx 或 2000 cGy/8fx；非脊柱骨转移瘤建议采用常规放疗重新照射 800 cGy/1fx、2000 cGy/5fx 或 2400 cGy/6fx。确定最佳放疗方法/方案需要对整个人进行评估，包括预后、既往放疗剂量（如果适用）、对正常组织的风险、生活质量、成本影响以及患者目标和价值观。相关地，为了以患者为中心优化治疗相关毒性和生活质量，建议共同决策。根据已发表的数据，ASTRO 特别工作组的建议为有症状骨转移的姑息性放疗的最佳临床实践提供了信息。版权所有 © 2024 American放射肿瘤学协会。由爱思唯尔公司出版。保留所有权利。

This guideline provides evidence-based recommendations for palliative external beam radiation therapy (RT) in symptomatic bone metastases.The American Society for Radiation Oncology (ASTRO) convened a task force to address 5 key questions regarding palliative RT in symptomatic bone metastases. Based on a systemic review by the Agency for Health Research and Quality, recommendations using predefined consensus-building methodology were established; evidence quality and recommendation strength were also assessed.For palliative RT for symptomatic bone metastases, RT is recommended for managing pain from bone metastases and spine metastases with or without spinal cord or cauda equina compression. Regarding other modalities with RT, for patients with spine metastases causing spinal cord or cauda equina compression, surgery and postoperative RT are conditionally recommended over RT alone. Furthermore, dexamethasone is recommended for spine metastases with spinal cord or cauda equina compression. Patients with non-spine bone metastases requiring surgery are recommended postoperative RT. Symptomatic bone metastases treated with conventional RT are recommended 800 cGy in 1 fraction (800 cGy/1fx), 2000 cGy/5fx, 2400 cGy/6fx, or 3000 cGy/10fx. Spinal cord or cauda equina compression in patients ineligible for surgery and receiving conventional RT are recommended 800 cGy/1fx, 1600 cGy/2fx, 2000 cGy/5fx, or 3000 cGy/10fx. Symptomatic bone metastases in selected patients with good performance status without surgery or neurological symptoms/signs are conditionally recommended SBRT over conventional palliative RT. Spine bone metastases re-irradiated with conventional RT are recommended 800 cGy/1fx, 2000 cGy/5fx, 2400 cGy/6fx, or 2000 cGy/8fx; non-spine bone metastases re-irradiated with conventional RT are recommended 800 cGy/1fx, 2000 cGy/5fx, or 2400 cGy/6fx. Determination of an optimal RT approach/regimen requires whole person assessment, including prognosis, previous RT dose if applicable, risks to normal tissues, quality of life, cost implications, and patient goals and values. Relatedly, for patient-centered optimization of treatment-related toxicities and quality of life, shared decision-making is recommended.Based on published data, the ASTRO task force's recommendations inform best clinical practices on palliative RT for symptomatic bone metastases.Copyright © 2024 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.