Single Fraction versus Multiple Fraction Radiotherapy for treatment of painful bone metastases: A Prospective Study; Mansoura experience

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.