Valeriani, M., Scaringi, C., Blasi, L., Carnevale, A., De Sanctis, V., Bonome, P., . . . Enrici, R.M. (2015). Multifraction radiotherapy for palliation of painful bone metastases: 20 Gy versus 30 Gy. Tumori, 101, 318–322.
To compare multifraction radiation therapy schedules for the palliation of pain from bone metastases
The medical records of patients treated with either 20 Gy in five fractions or 30 Gy in 10 fractions of radiotherapy were used for data collection. Pain was assessed prior to and one month after treatment. Clinical response was graded as complete response (CR, pain resolution), partial response (PR, reductions of at least two points on a numeric scale), or no response (NR). The two groups' outcomes were compared according to radiotherapy schedule.
Retrospective, descriptive study
The overall response rate was 88.9%. In the 30 Gy group, the CR rate was 19% compared to 6.5% in the 20 Gy group (p = 0.019). The PR rate in the 30 Gy group was 68.3% compared to 83.1% in the 20 Gy group. There was no difference between groups in overall response rates. The mean decline in pain score was 3.2 in the 20 Gy group and 3.6 in the 30 Gy group. More patients in the 30 Gy group had multiple sites of bone metastases. The incidence of toxicity was higher in the 30 Gy arm (p = 0.0001). The most common toxicities were nausea, vomiting, and diarrhea. In the regression analysis, incorporating variables of age, radiation therapy site, gender, tumor type, and analgesic use did not reveal a statistic difference in outcomes between the groups.
Optimal doses and fractionation for the palliation of bone metastases-related pain were not defined. This study demonstrated similar pain relief with a more abbreviated course of treatment, suggesting that a shorter treatment course may be as effective as long-course treatment for pain palliation. This may result in less toxicity from radiation treatment.
The findings of this study suggested that short-term radiation treatment for pain from bone metastases may be as beneficial as longer term treatment, and it may have fewer adverse side effects. Additional research to develop evidence for the most beneficial radiation schedule is needed.