Single- Versus Multiple-Fraction Radiation Therapy for Painful Bone Metastases: A Systematic Review and Meta-analysis of Nonrandomized Studies

Abstract

PurposeSingle-fraction radiation therapy (RT) is a convenient and cost-effective regimen for the palliation of painful bone metastases, but is still underused. Randomized controlled trials comparing single- versus multiple-fraction RT are limited by generalizability. We compared the pain response rates after single- versus multiple-fraction RT in nonrandomized studies.Methods and MaterialsWe searched PubMed and Scopus from the inception of each database through August 2018. We sought to identify nonrandomized studies in which data on pain response rates could be extracted for single- and multiple-fraction RT. Our primary outcomes of interest were the overall and complete pain response rates in evaluable patients. The analysis was performed using a random-effects model with the Mantel-Haenszel method.ResultsOf the 3933 articles identified through our search, 9 met our inclusion criteria. Five of 9 included studies did not exclude patients with features of complicated bone metastases. A 1 × 8 Gy radiation schedule was frequently used in single-fraction therapy, and schedules of 5 × 4 Gy and 10 × 3 Gy were frequently used in multiple-fraction therapy. In the 9 studies, the overall response rate was 67% (884 of 1321 patients) for patients in the single-fraction arm and 70% (953 of 1360 patients) for those in the multiple-fraction arm (pooled odds ratio [OR]: 0.85; 95% confidence interval [CI], 0.66-1.08). In 5 studies, the complete response rate was 26% (195 of 753 patients) for patients in the single-fraction arm and 35% (289 of 821 patients) for those in the multiple-fraction arm (pooled OR: 0.89; 95% CI, 0.70-1.13).ConclusionsThere were no significant differences in the overall and complete response rates between single- and multiple-fraction RT. The effectiveness of single-fraction regimens was shown in nonrandomized settings, which better reflect daily practice than randomized studies. The CIs for the pooled ORs included clinically meaningful differences, and the study results are inconclusive.

Patterns of Palliative Radiotherapy Utilization for Patients With Metastatic Breast Cancer in Harare, Zimbabwe

“…38 This is convenient and cost-effective, yet still underused. [39][40][41] In our study, fewer patients had singlefraction treatments, similar to results from a recent Ethiopian study. 42 Several reasons may justify the choice of longer fractionation.…”

Analgesic radiation therapy for bone metastasis in Dakar

“…It should be noted that randomised studies and meta-analyses do not show any superiority between these treatment regimens in the management of uncomplicated bone metastases. Moreover, they show that the hypofractionated regimen was more commonly used by experienced radiotherapists [13], [16], [17], [14]. The study by Slotman et al showed that the majority of patients preferred a one-day management [18].…”

Palliative radiotherapy for painful lymph node metastases

“…Radiotherapy is an important treatment option for cancer-related pain [1,2]. The pain response rate after radiotherapy for painful various tumors was reportedly 47-80% [3][4][5][6]. Among them, radiotherapy for painful bone metastases, which has been investigated extensively [3,6,7], was strongly recommended by the World Health Organization [8].…”

“…The pain response rate after radiotherapy for painful various tumors was reportedly 47-80% [3][4][5][6]. Among them, radiotherapy for painful bone metastases, which has been investigated extensively [3,6,7], was strongly recommended by the World Health Organization [8]. However, there are few studies of palliative radiotherapy for painful tumors other than bone metastases [9].…”