Palliation of Metastatic Bone Pain: Single Fraction versus Multifraction Radiotherapy – A Systematic Review of Randomised Trials

Evaluation of the quality of radiotherapy randomized trials for painful bone metastases

“…S everal recent metaanalyses of randomized radiotherapy studies have investigated the role of differing fractionation schedules for palliation of painful bone metastases. 1,2 The quality of previous evidence in this area has been questioned, 3 and it is known that poorquality randomized studies may potentially invalidate the results and conclusions of individual studies and subsequent metaanalyses. 4 In particular, subjective end points such as retreatment rates (an important end point for many patients 5 ) may not be reliably ascertained due to potential biases that are a direct result of study design, a finding acknowledged by several authors.…”

“…Most authors reviewing the quality of studies investigating analgesic interventions (including studies evaluating radiotherapy) have used Jadad's instrument, which is the only validated tool currently available. 1,2,4,28,29 This instrument was specifically designed for use in assessing randomized studies in pain research, but is not without drawbacks. One limitation is that it has only been validated for English-language studies published in full form.…”

“…Many of the other items included in the CONSORT and ICMJE recommendations were evaluated in Jadad's initial validation research, but were subsequently excluded from the final instrument due to the lack of face validity, reliability, or discriminative power. 8 Despite the acknowledged importance of evaluating and reporting study quality, recent metaanalyses 1,2 failed to comprehensively report the quality of those included. Others have noted this problem, 25 and we provide the only complete quality assessment.…”

“…However, as the eligible studies all rated poorly in our evaluation (using the same checklist that Wu et al used), it is not surprising that study quality had no effect because there were no high-quality studies with which to compare. Sze et al, 2 in a similar metaanalysis, mentioned that all included studies were evaluated using the assessment scale proposed by Jadad. Disappointingly, scores are neither reported nor used as a weighting factor for subsequent analyses.…”

Advances in the therapy of cancer pain: from novel experimental models to evidence-based treatments

“…Radiation therapy is another therapeutic modality frequently used for palliation against painful metastatic disease. Sze et al reviewed randomized studies comparing single fraction radiotherapy with multifraction radiotherapy on metastatic bone pain relief and prevention of bone complications (152). Eleven trials that involved 3435 patients were identified.…”