Two independent literature searches were conducted. The first was a search of PubMed (National Library of Medicine) for the years 1980 to 2000 with no language restrictions, using the search terms "bone", "metastasis" or "metastases", "radiation" or "radiotherapy", and "fraction". Citations listed in the PubMed output were evaluated for eligibility for the systematic review of the evidence as were those marked "Related" to the eligible papers.
The second search was conducted to complement the results of the search described above. In addition to several randomized controlled trials (RCTs), the original literature search had found five systematic reviews, the most recent of which covered the literature up to August 1998. For this practice guideline report, a second search of MEDLINE, CANCERLIT, and the Cochrane Library (2002, Issue 4) was conducted to find randomized trials published between January 1998 and December 2002 using MeSH headings (radiotherapy, radiotherapy dosage, dose fractionation, bone neoplasms/sc [Secondary], explode Clinical Trials, clinical trial [publication type]), and text words (bon:, osseous, metasta:, radiotherapy, irradiation, radiation, pain, analgesi:, trial, and study) without language restrictions.
Proceedings of the meetings of the American Society for Therapeutic Radiology and Oncology (ASTRO) (2001-2002) and the Canadian Association of Radiation Oncologists (2000), as well as reference lists of papers and review articles, were scanned for additional citations. The Physician Data Query (PDQ) clinical trials database on the Internet (http://www.cancer.gov/search/clinical_trials/) was searched for reports of ongoing randomized trials. The Canadian Medical Association Infobase (http://www.cma.ca/cpgs/index.asp), the National Guidelines Clearinghouse (http://www.guideline.gov/) and other web sites were searched for existing evidence-based practice guidelines prior to the development of this guideline report.
Inclusion Criteria
Articles were selected for inclusion in the systematic review of the evidence if they met all of the following criteria:
- They were published reports of either a systematic review of radiotherapy dose fractionation studies or full or abstract reports of results from randomized controlled trials comparing two or more dose-fractionation schedules for localized radiotherapy of painful bone metastases.
- The article reported data on pain relief for each intervention group.
Exclusion Criteria
Studies of hemi-body radiotherapy or systemic radiotherapy with radionuclides were excluded. Letters and editorials were not considered.