Example data entry and display for the BMET Decision Support Platform, to be published on Oncospace (Johns Hopkins Department of Radiation Oncology), pending peer review and publication.

This tool can be used at the time of consultation for palliative radiotherapy to symptomatic bone metastases in order to estimate patient survival time following consultation. Survival predictions are based on the BMET machine learning model (link to publication pending).

Providers can use this prognostic information and associated guidelines-based treatment recommendations to aid in decision-making for radiotherapy, chemotherapy, open surgery, and hospice referral interventions in patients with cancer metastatic to the bone.

Enter your patient’s information below.

If a value is unknown, leave the entry blank or unselected.

Non-small cell lung cancer
Chest wall
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IV therapy
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Most recent lab values, within the prior 6 weeks:

(cells/cubic mm)
(cells/cubic mm)

Predicted Survival Curve

The interactive orange plot above demonstrates the predicted survival curve within the 12 months following radiation oncology consultation for the specific patient based on the characteristics selected above. The blue curves demonstrate the predicted survival for all other patients with symptomatic bone metastases in the BMET database, arranged from lowest (dark blue) to highest (light blue) predicted survival. These blue curves are displayed for comparison purposes only.

NOTE: Both the plot displaying the patient’s predicted survival and the consensus-based recommendations below reflect a predicted value from the BMET model. While the model is calibrated to be as accurate as possible across all patients, the predicted survival time may underestimate or overestimate an individual patient’s actual survival time.

Treatment recommendations for a predicted median survival of 2.0 months.


Discussion of prognosis: Recommended

Prognosis should be discussed early in the course of terminal illness, ideally within 1 month of diagnosis with the terminal illness.

ASCO Patient-Clinician Communication Consensus Guidelines 2017

Radiotherapy: Consider shorter fractionation radiotherapy

Palliative radiotherapy for bone metastases can be considered in patients with life expectancy greater than days to weeks.

NCCN Palliative Care Guidelines V2.2019

High-quality data demonstrate that 30 Gy/10 fractions, 20 Gy/5 fractions, and 8 Gy/1 fraction provide equivalent pain control for uncomplicated** chest wall sites . 8 Gy/1 fraction optimizes convenience but is associated with a higher retreatment rate.

ASTRO Bone Metastasis Guidelines 2017 , ACR Appropriateness Criteria None-spine Bone Metastases 2015

Per NCCN non-small cell lung cancer guidelines, 8 Gy/1 fraction or 20 Gy/5 fractions is recommended for any bone metastasis in patients with poor performance status (likely corresponds to KPS < 70 ).

NCCN Non-Small Cell Lung Cancer Guidelines V3.2019

Stereotactic radiotherapy would not usually be appropriate in this setting.

ACR Appropriateness Criteria None-spine Bone Metastases 2015

** “Uncomplicated” metastases are painful lesions unassociated with impending or existing pathologic fracture or existing spinal cord or cauda equina compression. Presence of these features generally led to exclusion from trials comparing single versus multiple fraction radiotherapy. Soft tissue component was not used as an exclusion criterion in any these trials and is thus not considered a definite “complicating” factor.

Definition of Uncomplicated Bone Metastasis 2015

Open surgery:   No definite contraindication

Open surgery to chest wall sites is contraindicated for life expectancy <2 months.

Institutional practices

Cancer-directed systemic therapy:   No definite contraindication

Cancer-directed therapy should no be continued or initiated in patients with either of the following:

·       Solid tumors and low performance status (ECOG 3 or 4, corresponding to KPS <50). Exceptions include: those with disease characteristics (e.g., mutations) that suggest a high likelihood of response to therapy

ASCO Choosing Wisely Consensus Recommendations 2013

·       Life expectancy < 2 weeks

ASCO Quality Oncology Practice Initiatives 2018

Hospice referral discussion:   No definite contraindication

Hospice referral is recommended for patients with life expectancy <6 months.

Hospice Referral Eligibility 2016