One randomized study of moderate quality (Van Der Linden 2003) demonstrated that multi- fraction radiation therapy was associated with a lower risk of femoral fracture compared to single-fraction radiation therapy. In the absence of other randomized data, the strength of this recommendation was
upgraded to moderate given the significant morbidity associated with post- radiation femoral fractures which impact weight bearing and quality of life. In patients with limited life expectancies, a single fraction may be suitable to limit time on radiation treatment.
Treatment of Metastatic Carcinoma and Myeloma of the Femur
Joint MSTS/ASTRO/ASCO Guideline
Rationale