SUPR-3D: Simple Unplanned Palliative Radiotherapy Versus 3D Conformal Radiotherapy for Patients With Bone Metastases

Participation Requirements

• Sex:

  ALL

• Eligible Ages:

  18 and up

Participation Criteria

Inclusion Criteria:

* Age 18 or older
* Able to provide informed consent
* Clinical diagnosis of cancer with bone metastases (biopsy not required)
* Currently being managed with palliative intent RT to 1-3 RT fields for bone metastases, at least one RT field (PTV) must (at least) partly lie within T11-L5 or pelvis.
* ECOG Performance Status 0-3
* Patient has been determined to potentially benefit from 8 Gy or 20 Gy
* Radiation Oncologist is comfortable prescribing 8 Gy in 1 fraction or 20 Gy in 5 fractions RT for bone metastases
* Negative pregnancy test result for women of child-bearing potential
* The baseline assessment must be completed within required timelines, prior to randomization.
* Patients must be accessible for treatment and follow-up. Investigators must assure themselves the patients randomized on this trial will be available for complete documentation of the treatment, adverse events, and follow-up.
* For simplicity of planning, expected GTV should be less than 20 cm based on radiological or clinical evidence
* Patient must be prescribed a 5-HT3 receptor antagonist (e.g. Ondansetron) as antiemetic prophylaxis prior to RT start.
* Patient is able and willing to complete the quality of life questionnaires, and other assessments that are a part of this study, via paper or using PatientPortals.ca or REDCap if they provide their email address on the informed consent

Exclusion Criteria:

* Serious medical co-morbidities precluding radiotherapy
* Clinical evidence of spinal cord compression
* Spinal cord in treatment field has already received at least \>30 Gy EQD2
* Whole brain radiotherapy (WBRT) within 4 weeks of RT start or planned WBRT in the first 4 weeks after last RT
* Solitary plasmacytoma
* Pregnant or lactating women
* Target volume cannot be encompassed by a single VMAT isocentre
* Custom mould room requirements (shells and other immobilization that is standard-of-care is acceptable)
* Greater than two organs-at-risk requiring optimization.
* Patients requiring treatments outside standard clinical hours
* Implanted electronic device within 10 cm of the RT fields
* Prostheses in the axial plane of the target, or within 1 cm of the PTV out-of-plane
* Previous RT that requires an analysis of cumulative dose (i.e. sum plans or EQD2 calculations)
* Oral or IV contrast if the local standard-of-care requires compensation for this in planning.