34. A multicenter randomized study of two regimens in paliative radiotherapy of bone metastases

In this study we compared two methods of radiotherapy in patients with painful bone metastases: 20 Gy in five fraction in five consecutive days vs 8 Gy in one fraction. A total of 115 patients (34 males, 81 females), median age 56 years (23–80), were randomly allocated to one of the treatment arms. In 56 pts. Primary tumor was located in the breast, in 14 pts in the lung, in ten pts in the kidney, in seven pts in the prostate, and in 28 pts in other sites. A total of 146 metastatic bone lesions were irradiated, seventy five (51%) were treated with 20 Gy and seventy one (49%) – with 8 Gy. The most frequent location of metastatic lesions was spine (36%), followed by pelvis (25%), long bones (18%), ribs (12%) and other sites (12%). Treatment techniques included single field (73%) or two parallel opposed fields (27%). Complete pain relief was achieved in 36% of the lesions irradiated with 20 Gy and in 41% of those irradiated with 8 Gy. Partial improvement was observed in 46% and 43% of lesions, respectively. The median time to reappearance of pain in both groups was 5.4 a 4.8 months and 5.0 a 5.4 months respectively. We conclude that a single exposure to 8 Gy is of the same efficacy as 20 Gy in five fractions in pain control of bone metastases and should be recommended as routine management

20 Gy in five fractions versus 8 Gy in one fraction in palliative radiotherapy of bone metastases : a multicenter randomized study

ntroduction. Bone is the most common site of cancer dissemination and 70% of patients with bone lesions present with pain requiring therapy. Radiotherapy plays a major role in the treatment of painful bone metastases, but optimal dose and fractionation regime remain debatable. Material and methods. To address this issue a randomized trial comparing a single dose of 8 Gy vs. 20 Gy in 5 fractions was performed and enrolled 115 patients with 146 metastatic lesions. Pain relief was assessed longitudinally based on a pain questionnaire, in which patients were supposed to record their pain intensity using a 4-point scale (none, mild, moderate, severe), as well as doses and types of analgesic drugs taken. Questionnaires were collected prior to treatment, 2, 4 and 8 weeks after treatment completion and every 4 weeks thereafter Results. Complete pain relief was achieved in 23 patients (36%) treated with one fraction of 8 Gy and in 24 patients (39%) who received 20 Gy in 5 fractions (p=0.96). Remarkable pain relief after one fraction and 5 fractions was achieved in 21 patients (33%) and 18 patients (29%), respectively (p=0.89) and moderate pain relief in 9 patients (14%) and 10 patients (16%), respectively (p=0.94). There was also no difference between the two treatment regimes according to duration of pain relief (medians of 8 and 10 months, respectively). Conclusions. Single fraction of 8 Gy is equally effective to a fractionated schedule in the treatment of painful bone metastases, and should be recommended as standard care in the majority of patients