Bone metastases present a frequent problem in oncology. Although fractionated irradiation with 10–15 (20) fractions is the best mode of radiotherapy, low-dose short-term irradiation schedules are of interest as they will reduce inconveniences like transportation problems. In two consecutive prospective follow-up studies patients with painful non-vertebral bone metastases were irradiated with a single shot (4 Gy) treatment or four fractions with 4 Gy. Response rates and duration of response are significantly better with the 4×4 Gy schedule. From these data and recently published data a more individualised pain management is proposed.
In this study 4 x 4 Gy proved to be clearly superior to 1 x 4 Gy in relieving pain from symptomatic nonvertebral bone metastases without impending pathologic fracture. Even if radiotherapy with 1 single fraction seems to be applicable in specific cases doses higher than 4 Gy should be chosen. In breast cancer patients pain control seems to be better compared to other primaries.
A slower development of motoric deficits before beginning of radiotherapy means a better therapeutic effect and a more favorable functional outcome after treatment. The prognosis is extraordinarily poor if severe deterioration of motoric function occurs within 48 hours before radiotherapy.
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