Efficacy of radiotherapy for painful bone metastases during the last 12 weeks of life

Abstract

for the Dutch Bone Metastasis Study Group BACKGROUND: Radiotherapy is an effective treatment for painful bone metastases. Whether this applies also in patients with limited survival remains to be investigated. This study analyzed the effect of radiotherapy for painful bone metastases in patients with a survival 12 weeks. METHODS: In the Dutch Bone Metastasis Study, 1157 patients with painful bone metastases were randomized to single fraction (1 Â 8 grays [Gy]) or multiple fraction (6 Â 4 Gy) radiotherapy. Patients who died within 12 weeks after randomization were included in this analysis. Patients were classified as responders or nonresponders, based on their pain response to radiotherapy. This response was calculated considering changes in pain intensity (measured with an 11-point numeric rating scale) and analgesic usage. Cox proportional hazards models were used to analyze pain response and survival. RESULTS: Two hundred seventy-4 patients were included in this analysis. At randomization, the mean pain intensity score (AEstandard deviation) was 7 (AE2). The proportion showing a pain response did not differ between the single fraction and multiple fraction groups. Toward death, pain intensity score decreased to 5 (AE3) in responders (45%), whereas in nonresponders (55%) no change was observed. Despite the benefit in responders, in 60% of all patients pain intensity remained 5 after randomization. CONCLUSIONS: Pain responded in about half of the patients who survived 12 weeks after randomization into the Dutch Bone Metastasis Study. When considering radiotherapy, single fraction should be preferred. Additional palliative measures remain essential for adequate pain control. Cancer 2010;116:2716-25.

Effectiveness of Repeat Radiotherapy for Painful Bone Metastases in Clinical Practice: A 10 Year Historical Cohort Study

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Early evaluation predicts pain relief of irradiated bone metastases: a single-center prospective study

“…Unfortunately, patients with a very poor performance status at the BT, have a low probability of improving their performance status because many factors contribute to this status. However, one study showed that such patients with a short life expectancy may benefit from analgesic irradiation [22]. …”

MR-guided high-intensity focused ultrasound for noninvasive cancer treatment

“…Bone pain is a common event in patients with skeletal metastases, leading to immobility and decreased quality of life in cancer patients. In addition to pain medication, palliative radiotherapy is the standard of care for patients with uncomplicated localized metastatic bone pain [ 27 ] . Palliative radiotherapy is effective in around 60–70% of patients, and only around 30% of responding patients are totally pain free [ 28 ] .…”