Management
BMAs for Various Diagnoses
➤ In the absence of reliable evidence, it is the opinion of the workgroup
that BMAs should be considered in patients with metastatic carcinoma
or multiple myeloma with bone lesions at risk for fracture regardless of
tumor histology. (
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)
Imaging Findings and Atypical Fractures
➤ In the absence of reliable evidence, it is the opinion of the workgroup
that imaging findings of lateral cortical thickening may be associated
with increased atypical femur fracture risk. (
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)
Efficacy of Radiation Therapy
➤ Clinicians should consider the use of radiation therapy to decrease the
rate of femur fractures in patients with metastatic carcinoma or multiple
myeloma lesions who are deemed at increased risk based on the
combination of imaging findings and lesion-related pain. (
★★★★
)
Radiation Therapy and Prophylactic Femur Stabilization
➤ In the absence of reliable evidence, it is the opinion of the workgroup
that clinicians may consider the use of radiation therapy in patients
undergoing prophylactic femur stabilization to reduce pain, improve
functional status, and reduce the need for further intervention.
(
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)
Radiation Therapy after Resection and Reconstruction
➤ In the absence of reliable evidence, it is the opinion of the workgroup
that radiation therapy may be considered after resection and
reconstruction to reduce pain, improve functional status, and reduce
the need for further intervention in patients with residual tumor, or
those at increased risk of tumor recurrence in the setting of metastatic
carcinoma or multiple myeloma of the femur. (
★★★★
)
Multi-Fraction Radiation Treatment
➤ Clinicians should consider the use of multi-fraction in lieu of single
fraction radiation treatment to reduce the risk of fracture in patients
with metastatic carcinoma in the femur. (
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)
ASCO CPGC Addendum on Radiation: If stem-cell transplantation is under
consideration, the potential effects of radiation therapy on the transplantation should be
considered as part of shared decision-making.
