“There are multiple treatments for prostate cancer, which we’ve already known, but we’re reinforcing the shared decision model between patient and physician by including this on our list,” said Steinberg.

Don’t routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases.

Studies have suggested an equivalent pain relief following 30 Gy in 10 fractions, 20 Gy in 5 fractions or a single 8 Gy fraction. While a single treatment is more convenient, it may be associated with a slightly higher rate of re-treatment to the same site, making it a choice physicians should consider for patients with transportation difficulties or an unpromising prognosis.

“This data has existed for a while but has been slow on the uptake, not entirely because of financial reasons, but also based on past training,” said Steinberg. “We’re reemphasizing the existence of evidence in an effort to move the needle.”

Don’t routinely use intensity modulated radiation therapy (IMRT) to deliver whole breast radiotherapy as part of breast conservation therapy.

The final recommendation comes in response to observed confusion regarding to the term IMRT. In clinical trials, the term “IMRT” was applied to describe methods that should be defined as “field-in-field 3-D conformal radiotherapy.”

While 3-D conformal treatments have been linked to lower rates of skin toxicity, IMRT itself is better used for special breast cancer treatments involving unusual anatomy, but in general, its routine use has not shown significant clinical advantage.

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