This study was designed to prospectively evaluate quality of life in patients treated with local external beam radiation therapy for symptomatic bone metastases. Patients with symptomatic bone metastases treated with palliative radiation therapy were followed with Edmonton Symptom Assessment Scale (ESAS) at baseline and at 1, 2, 4, 8, and 12 weeks after the delivery of radiation therapy. The ESAS evaluates 10 symptoms: global pain, index pain (pain at the irradiated site), fatigue, nausea, depression, anxiety, drowsiness, appetite, sense of well-being, and shortness of breath on a categorical score of 0 to 10 (0 = absence of symptom, 10 = worst possible symptom). At each follow-up interval, the difference for each domain of the ESAS was compared with the baseline score. A P value < 0.01 was considered significant. Five hundred and eighteen patients were analyzed in this study. For the entire cohort, there were statistically significant improvements with the delivery of palliative radiation therapy in global pain, index pain, anxiety, sense of wellbeing, and shortness of breath in >/= 1 follow-up interval. Fatigue was reported to be slightly worse in the first 2 weeks following the radiation treatment. Global pain, index pain, anxiety, and sense of well-being showed consistent improvement with the radiation treatment regardless of which endpoint definitions were employed. Radiation therapy not only can palliate pain but also can improve quality of life.