Table 1 Full inclusion and exclusion criteria

Inclusion

Patients of 18 years or older

Uncomplicated painful bone metastases

Primary malignancy is a solid tumor

Pain intensity on a numeric rating scale of 2-8

No immediately expected change in the analgesic regimen.

Indication for single or short course radiotherapy

Able to fill out Dutch questionnaires

Able to follow instructions

Informed consent provided

Exclusion

Patients with haematological malignancy

Multiple sites to be irradiated

Patients who have been treated before with palliative radiotherapy for painful bone metastases to the same bony localisation

Current use of steroids (dexamethasone, prednisolone or other), use up to less than a week before randomization or expected use within 2 weeks after start of radiotherapy (e.g., as part of anti-emetic regimen for chemotherapy)

Contraindications for the use of dexamethasone (to be judged by the radiation-oncologist)

Long-term schedule radiotherapy (>6 fractions)

Life expectancy shorter than 8 weeks

Karnofsky performance score of 40 or less