Comparison of three different radiation fractionation schedules in the palliation of painful bone metastasis.

Abstract

9055 Background: The purpose of this study was to compare the efficacy of a single fraction versus two multifractionated regimens in the palliation of painful bone metastases. Methods: Patients with painful bone metastases were randomized into three groups. Group I received a dose of 8 Gy in a single fraction, Group II received 20 Gy in five fractions and Group III patients received 30 Gy in 10 fractions. Pain score, ECOG performance status and analgesic requirement were recorded at baseline and at 1, 4, 8 and 12 weeks following treatment. Pain score was recorded on a 5-point verbal rating scale from 0 (no pain) to 4 (extremely severe pain). Overall response was defined as decrease in pain score by at least one point. Complete response was defined as achieving a pain score of zero at any point during follow-up. Duration of overall response was defined as the time from initial response till return of pain to its baseline value. Results: 45 patients were included with 15 in each group. Median age was 55 years (range 29-78 years). 17(37.7%) had metastasis in pelvic bones; 17(37.7%) in the spine while the remainder in the appendicular bones. Overall response rates in Groups I, II and III at week 1 were 60%, 53.3% and 60% respectively (p=0.71). At 1 month, overall response rates were 71.4%, 73.3% and 73.3% (p=0.84) and at 3 months; 78.5%, 80% and 80% respectively (p=0.86). The rate of complete response in all the three groups was 20%. Improvement in performance status in Groups I, II and III was seen in 60%, 66% and 80% respectively (p=0.69). Analgesic usage decreased in 86%, 87% and 80% patients in groups I, II and III respectively (p=0.66). Out of the nine complete responders, two sustained the response for less than four weeks, four patients up to eight weeks and remaining three till the end of follow-up. There was no statistically significant difference in between the three arms among all the variables compared. Conclusions: All three groups showed equal efficacy in pain palliation, analgesic requirement, improvement in performance status and duration of response. In patients with very advanced disease and short life expectancy, where the treatment goal is to decrease pain, 8 Gy in single fraction is a convenient and cost effective schedule.

Dose Escalation for Oligometastatic Disease: Is More Better?

“…In particular, for painful bone metastasis, numerous trials have compared various lower dose radiation therapy schedules (eg, 8 Gy  1, 4 Gy  5, 3 Gy  10), with no differences in pain response. [1][2][3] Although the primary goal was met, many showed pain control durability of only 12 weeks and high rates of local failure in the few trials that tracked this outcome.…”