Radiotherapy for Patients with Bone Metastases

Eligibility Details: 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 bone metastases, at least one of which 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 - Pregnancy test for women of child-bearing potential - Patient is able (i.e. sufficiently fluent) and willing to complete the patient-reported outcomes quality of life questionnaires in English. 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 5HT-3 receptor antagonist (e.g. Ondansetron) or dexamethose as antiemetic prophylaxis prior to RT start. 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 within 4 weeks of RT start - 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.