Pain Management Policy: Comparison of Two Irradiation Schedules in Metastatic Bone Pain

Abstract

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.

Effectiveness of Hypofractionated Radiotherapy in Painful Bone Metastases

“…Our study compared the 4 ´4 Gy schedule with the 1 ´4 Gy schedule and established that 4 ´4 Gy provides significantly higher response rates (86.5% vs 48%) confirming our preliminary results from a smaller series published previously [12]. Other studies [9,12,22] also noticed lower response rates after a single fraction treatment of 4 Gy (between 35% and 48%), whereas response rates of 68% to 89% were reported for a total dose of 16 to 22.5 Gy given in 4 to 5 fractions [6, 12, 16-18, 23, 28].…”

“…In literature only few authors report on pain control with a follow-up of at least 2 to 3 months [9,10,12,16,28] with pain control rates after 1 ´4 Gy between 55 and 68% and after 4 ´4 Gy between 76% and 88% being comparable to our results.…”

“…Response was defined as an improvement by at least 1 point. Same or similar pain scales and response criteria were used by several authors [6,9,10,12,16,28] providing better comparability between our results and published data.…”

“…Other studies [9,12,22] also noticed lower response rates after a single fraction treatment of 4 Gy (between 35% and 48%), whereas response rates of 68% to 89% were reported for a total dose of 16 to 22.5 Gy given in 4 to 5 fractions [6, 12, 16-18, 23, 28].…”

“…Previously published data from a smaller series [12] were included. Patients were eligible only when multiple metastases (bone or visceral) were present and the estimated life expectancy was 6 months or less.…”