The American Society for Radiation Oncology (ASTRO) has updated its guideline on palliative radiation therapy for bone metastases. The revised guidance is based on 20 randomized trials, 32 prospective nonrandomized studies, and 4 meta-analyses/pooled analyses. Among the recommendations:

• Available literature continues to support pain relief equivalency between single and multiple fraction regimens for bone metastases.
• High-quality data confirm that single fraction radiation therapy may be delivered to spine lesions with acceptable late toxicity.
• 1 prospective, randomized trial confirms both peripheral and spine-based painful metastases can be successfully and safely palliated with retreatment for recurrence pain with adherence to published dosing constraints.
• Advanced radiation therapy techniques lack high-quality data, leading the panel to favor its use in a clinical trial or when results will be collected in a registry.
• Surgery, radionuclides, bisphosphonates, and kyphoplasty/vertebroplasty do not obviate the need for external beam radiation therapy.