Franco, P., Migliaccio, F., Angelini, V., Cante, D., Sciacero, P., Peruzzo Cornetto, A., . . . Ricardi, U. (2014). Palliative radiotherapy for painful bone metastases from solid tumors delivered with static ports of tomotherapy (TomoDirect): Feasibility and clinical results. Cancer Investigation, 32, 458–463.
To evaluate the feasibility and efficacy of palliative radiation therapy given via static ports of tomotherapy
Tomotherapy is a treatment modality that delivers a series of highly modulated linear beam paths for hypofractionated palliative radiation therapy (RT). Doses given were 3 Gy in 10 fractions, 4 Gy in five fractions, or 8 Gy in one fraction. The selection of a schedule was individualized to patients. Pain was evaluated by physicians immediately before RT for current, worst within the past 24 hours, least, and average pain. Opioid consumption in the previous 24 hours was evaluated.
Prospective, observational study
At two weeks, response rates ranged from 49%–55% with no significant difference between the fractionation groups. Among all patients, opioid consumption decreased (p < 0.001). At two months, response rates decreased to 40%. The rate of no response was highest in the 8 Gy single fraction group. This group also had increased opioid use and more frequent retreatment.
RT is effective for pain relief in patients with painful bone metastases. This study suggested that the TomoDirect™ delivery of RT can be feasible and effective.
RT was effective for pain reduction in patients with painful bone metastases; however, the duration of palliation may be brief. Studies have suggested that multiple fractionation for RT delivery may be more effective.