Objective To investigate the analgesic efficacy,quality of life,and the incidence of adverse reactions of palliative radiotherapy combined with the principle of three-step analgesic ladder in treatment of metastatic bone pain in non-small cell lung cancer (NSCLC).Methods A total of 88 NSCLC patients with metastatic bone pain at Fujian Provincial Hospital from April 2015 to April 2018 were retrospectively analyzed.According to the treatment,the patients were divided into the combined group and the control group,and 44 cases in each group.The combined group was given palliative radiotherapy combined with the principle of three-step analgesic ladder,and the control group received the principle of three-step analgesic ladder.The analgesic efficacy,changes of quality of life,and the incidence of adverse reactions were compared between the two groups.Results The total analgesic effective rate in the combined group was higher than that in the control group [84.1％ (37/44) vs.54.5 ％ (24/44)],and the difference between the two groups was statistically significant (Z =-3.227,P =0.001).For mild and moderate pain,the effective rate in the combined group and control group were 84.6 ％ (11/13) vs.57.1％ (8/14),80.0 ％ (12/15) vs.42.9 ％ (6/14) respectively,and the differences were not statistically significant (Z =-1.473,P =0.141;Z =-1.793,P =0.073).For severe pain,the effective rates in the combined group and control group were 87.5 ％ (14/16) and 62.5 ％ (10/16),and the difference was statistically significant (Z =-2.327,P =0.020).The quality of life in the combined group was better than that in the control group,and the difference between the two groups was statistically significant (Z =-2.254,P =0.024).The overall incidence rate of adverse reactions in the combined group was 36.4 ％ (16/44),which was significantly lower than that in the control group [59.1％ (26/44)],and the difference between the two groups was statistically significant (x2 =4.55,P =0.033).Conclusion Palliative radiotherapy combined with the principle of three-step analgesic ladder in treatment of metastatic bone pain of NSCLC can significantly improve the efficacy,especially for severe pain,and improve the quality of life,and reduce the incidence of adverse reactions.