Palliative Single Versus Fractionated Radiotherapy for Bone Metastases
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- Category: Vol. 78, March 2010
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Palliative Single Versus Fractionated Radiotherapy for Bone Metastases, REHAM SAFWAT, AMANY ALBASMY, MOHAMAD ESSAWI and KHALED ALSHAHHAT
Abstract
Background and Objective: The debilitating pain that occurs in many patients with advanced malignancies is pri-marily produced by bone metastases. In 75% of patients with bone metastases (BM) pain is the dominant symptom. Radio-therapy is often used to treat painful metastatic lesions to bone. There has been controversy over the most effective method of delivering radiotherapy for this purpose. One relatively standard approach is to deliver 30 Gy in 10 treatment fractions. However, this if often inconvenient to patients and their families and some have advocated shorter courses of radiotherapy. In addition to being more inconvenient, longer courses of radiotherapy are much more expensive than a single dose. Although single- and multiple-fraction radiotherapy are thought to provide equal palliation. Several schedules of short and long fractionation XRT are used in clinical practice, with hypofractionated treatment being even more attractive for practical reasons.
Objective: The aim of this study is to compare single fraction 8 Gys with the standard treatment course of 30 Gys/10 fractions/2 weeks regarding factors impacting on quality of life (QoL) in terms of improved pain, mobility, analgesia scores, and performans status in patients with multiple un-complicated BM.
Outcome Measures: The primary endpoints were pain relief by visual analogue score (VAS), four-point categorical pain scale, and analgesic consumption.
Patients and Methods: Sixty patients with bone metastases from known primary sites divided into 2 groups each of 30 patients balanced in age, sex, and type of malignancy, to be treated with one of two RT regimens. The primary tumor was in the breast in 36.6% of patients, in the prostate in 25% of patients, in the lung in 21% of patients and in other locations in 16.6% of patients. Evaluation was performed before and 4, 8, and 12 weeks after completion of treatment. Of 60 eligible patients, 30 were randomized to the 8 Gys arm, and 30 were randomized to the 30Gys arm.
Results: Overall, the treatment was well tolerated. Overall response rate was seen in (48/60) 81.6% of cases, whereas complete response was seen in 28.3% (17/60) of cases and partial response in 51.6% (32/60).
Complete and partial response rates were 26.6% and 50%, respectively with an overall response rate (ORR) is 76.6%, in the 8 Gys arm, compared with 30% and 53.3%, respectively, with an ORR of 83.3% in the 30 Gys arm (p>0.5). At 3 months, 26.6% of patients in the 8 Gys arm and 30% of patients in the 30 Gys arm no longer used narcotic medications. Pathologic fractures occurred within the treatment field of 6.6% and 3.3% of patients in the 8 Gy and 30 Gy arms, respectively. Significantly more patients in the 8 Gys arm were re-treated compared with the 30 Gys arm (1-year re-treatment rates: 13.3% versus 3.3%, p<0.001).
Conclusion: At 3 months, a single dose of 8 Gys is equivalent to 30 Gys in providing pain relief and narcotic relief to patients with painful bone metastasis. There was a higher re-treatment rate, but less acute toxicity, among patients in the 8 Gy arm compared with the 30 Gy arm.