Suggested algorithmic approach to local management for non-vertebral bone metastases from solid tumors

Assumes optimization of systemic therapy. First-line therapies for bone pain include adequate analgesia with nonsteroidal antiinflammatory drugs with or without opioids. Osteoclast inhibitors are recommended for most patients with bone metastases to enhance analgesia and prevent skeletal-related events. Algorithm not applicable to patients with multiple myeloma.

PS: performance status; EBRT: external beam radiation therapy; SBRT: stereotactic body radiotherapy; CRPC: castration-resistant prostate cancer.
* Assess fracture risk using a validated classification system, such as Mirels scoring system. Refer to UpToDate text.
¶ If observation is chosen, consider periodic repeat imaging and treat with EBRT if the lesion progresses or there is impending fracture.

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Suggested algorithmic approach to local management for non-vertebral bone metastases from solid tumors