Abstract
Purpose: Assessment of pain response in patients with bone metastasis after treating with two radiation schedules and to compare toxicity profile in both arms.
Patients & Methods: A prospective randomised study was designed to include 100 patients from May 2011 to May 2013. Patients with histopathologically proven primary malignancy having symptomatic secondary deposits to bone were selected for the study. Patients were randomised to 8 Gy in a single fraction (arm A) or 20 Gy in five fractions (arm B). Initial pain response was assessed using numeric rating scale, and compared using the same scale 3 months after completion of treatment. Acute toxicities were assessed using the radiation therapy oncology group criteria for adverse events
Results: Arm A comprised 51 patients while 49 patients were enrolled in Arm B. Baseline patient characteristics were comparable. Twelve patients were lost to follow-up. So the 3-month pain score assessment was completed by 88 of the 100 patients; A complete response was observed in 20.4% (18 patients) of the 88 patients, and partial response was observed in 54.5% (48 patients), for an overall response rate of 75% (66 of 88 patients); only 10% (9 patients) of the 88 patients had progression of pain. Mild GI toxicity was noted in both arms but differences in two arms were not statistically significant (p = 0.45), no interruption of treatment was required because of side effects.
Conclusions: In our study, we found both the radiation fractionation schedules for palliative bone metastasis treatment is equally effective in pain control.
References
[1] Agarawal JP, Swangsilpa T, van der Linden Y, Rades D, Jeremic B, Hoskin PJ. The role of external beam radiotherapy in the management of bone metastases. Clin Oncol (R Coll Radiol) 2006; 18:747-60.
[2] Sze WM, Shelley MD, Held I, Wilt TJ, Mason MD. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy a systematic review of randomised trials. Clin Oncol (R Coll Radiol).2003; 15(6):345-352.
[3] Chow E, Zeng L, Salvo N, Dennis K, Tsao M, Lutz S. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol (R Coll Radiol). 2012; 24(2):112-124..
[4] Bone Pain Trial Working Party. 8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomized comparison with a multifraction schedule over 12 months of patient follow-up. Radiotherapy Oncol 1999; 52:111-21.
[5] Wu JS, Wong R, Johnston M, Bezjak A, Whelan T, on behalf of the Cancer Care Ontario Practice Guidelines Initiative Supportive Care Group. Metaanalysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol Biol Phys 2003; 55:594-605.
[6] Chow E, Harris K, Fan G, Tsao M, Sze WM. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol. 2007; 25(11):1423-1436.
[7] McQuay HJ, Collins SL, Carroll D, Moore RA. Radiotherapy for the palliation of painful bone metastases. Cochrane Database Syst Rev. 2000;(2):CD001793.
[8] Chow E, Danjoux C, Wong R, et al. Palliation of bone metastases: a survey of patterns of practice among Canadian radiation oncologists. Radiotherapy Oncol 2000; 56:305-14.
[9] Ben-Josef E, Shamsa F, Williams AO, Porter AT. Radiotherapeutic management of osseous metastases: a survey of current patterns of care. Int J Radiat Oncol Biol Phys 1998; 40:915-21.
[10] Roos DE. Continuing reluctance to use single fractions of radiotherapy for metastatic bone pain: an Australian and New Zealand practice survey and literature review. Radiother Oncol 2000; 56:315-22.
[11] Steenland E, Leer JW, van Houwelingen H, et al. The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study. Radiotherapy Oncol 1999; 52:101-9.
[12] Hartsell WF, Scott CB, Bruner DW, et al. Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst 2005; 97:798-804.
[13] Kirkbride P, Warde P, Panzarella T, Aslanidis J, McKenzie M, Sun A. A randomized trial comparing the efficacy of a single radiation fraction with fractionated radiation therapy in the palliation of skeletal metastases [abstract]. Int J Radiat Oncol Biol Phys 2000; 48(suppl):185.
[14] Roos DE, Turner SL, O’Brien PC, Smith JG, Spry NA, Burmeister BH, et al. Randomized trial of 8 Gy in 1 versus 20 Gy in 5 fractions of radiotherapy for neuropathic pain due to bone metastases (Trans- Tasman Radiation Oncology Group, TROG 96.05). Radiother Oncol 2005; 75:54-63.
[15] Ben-Josef E, Shamsa F, Williams AO, Porter AT. Radiotherapeutic management of osseous metastases: A survey of current patterns of care. Int J Radiat Oncol Biol Phys 1998; 40:915-21.
[16] Haddad P, Wong RK, Pond GR, Soban F, Williams D, McLean M, et al. Factors influencing the use of single vs. multiple fractions of palliative radiotherapy for bone metastases: A 5-year review. Clin Oncol (R Coll Radiol) 2005; 17:430-4.
[17] Chow E, Lutz S, Beyene J. A single fraction for all, or an argument for fractionation tailored to fit the needs of each individual patient with bone metastases? Int J Radiat Oncol Biol Phys 2003; 55:565-7.
[18] Majumder D, Chatterjee D, Bandyopadhyay A, et al. Single Fraction versus Multiple Fraction Radiotherapy for Palliation of Painful Vertebral Bone Metastases: A Prospective Study Indian Journal of Palliative Care 2014;Vol-18 / Issue3:202-206
[19] Fairchild A, Barnes E, Ghosh S, et al. International patterns of practice in palliative radiotherapy for painful bone metastases: evidence based practice? Int J Radiat Oncol Biol Phys 2009;75:1281-1628.
[20] Janjan N, Lutz S, Bedwinek J, et al. Therapeutic guidelines for the treatment of bone metastasis: A report from the American College of Radiology Appropriateness Criteria Expert Panel on Radiation Oncology. J Palliative Medicine 2009; 12:417-426
[21] Konski A, James J, Hartsell W, et al. Economic analysis of radiation therapy oncology group 97-14: multiple versus single fraction radiation treatment of patients with bone metastases. Am J Clin Oncol.200 9; 32(4):423-428.
[22] Pollicino CA, Turner SL, Roos DE, O’Brien PC. Costing the components of pain management: analysis of Trans-Tasman Radiation Oncology Group trial (TROG 96.05): one versus five fractions for neuropathic bone pain. Radiother Oncol. 2005; 76(3):264-269.
[23] Van den Hout WB, van der Linden YM, Steenland E, et al. Single- versus multiple-fraction radiotherapy in patients with painful bone metastases: cost-utility analysis based on a randomized trial. J Natl Cancer Inst. 2003; 95(3):222-229.
[24] Konski A. Radiotherapy is a cost-effective palliative treatment for patients with bone metastasis from prostate cancer. Int J Rad Oncol Biol Phys. 2004;60(5):1373-1378.
