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When do you prescribe steroids prior to palliative radiotherapy of bone metastases to prevent pain flare?

The Canadian study presented at ASTRO 2015 showed a decrease in pain flare prior to single dose 8Gy RT, but steroids were given for 5 days prior to RT. We often treat less then 5 days after seeing a patient in this situation. Is this something that should be done routinely for painful mets treated with a single fraction? SBRT? What duration and dose of dexamethasone is appropriate?

Answer from: Radiation Oncologist at Academic Institution

Thanks for the interesting question. The dexamethasone was given 8mg one hour prior to single fraction radiotherapy (RT), then 8mg po daily with breakfast for four days subsequently (not five days prior to RT). A steroid taper was not utilized. Previous studies by this trial's PI investigated both a...

Please select the option that best describes you:

When do you prescribe steroids prior to palliative radiotherapy of bone metastases to prevent pain flare?

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