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Single 8-Gy radiotherapy dose reduces pain from bone metastases
Patients with one or two painful bone metastases reported pain reduction after treatment with a single 8-Gy dose of radiotherapy, according to a secondary analysis of the NCIC Clinical Trials Group Symptom Clinical Trial SC.23.
Forty percent of patients experienced pain reductions and improved quality of life as soon as 10 days after treatment, results showed.
“These results confirm that radiotherapy for painful bone metastases can improve pain and quality of life quickly after treatment and, therefore, should be offered even for those with a limited expected survival,” Rachel McDonald, MD, from the department of radiation oncology at Odette Cancer Center of Sunnybrook Health Sciences Center in Toronto, Canada, and colleagues wrote.
Pain and pathologic fractures from bone metastases can contribute to morbidity and decreased quality of life (QOL). Studies have shown radiotherapy has 60% to 70% efficacy in reducing pain, but there are limited data that use bone metastases–specific QOL measurement tools, and how soon radiotherapy has an effect is unknown.
In this analysis, McDonald and colleagues used the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Bone Metastases Module (QLQ-BM22) and the European Organisation for Research and Treatment of Cancer Quality of Life Core 15 Palliative (QLQ-C15-PAL) to measure differences among responders and nonresponders to a single 8-Gy radiotherapy dose to one or two bone metastases.
The analysis included 298 patients from the double blind NCIC Clinical Trials Group Symptom Control Trial SC.23, which investigated the use of dexamethasone for prophylaxis of pain flare after radiotherapy for painful bone metastases. Patients were recruited between May 2011 and December 2014 and followed up for 42 days after treatment.
Patients from the trial were referred for radiotherapy if they had a worst pain score of at least 2 on a scale of 0 (no pain) to 10 (worst possible pain). Patients reported their worst pain score and daily opioid analgesic intake at baseline, day 1, day 10 after treatment and day 42 after treatment.
Median age of patients was 68.8 years (range, 32-94) at day 10 and 68 years (range, 34-90) at day 42.
At day 10, 122 patients (40.9%) responded to radiotherapy, which included 37 complete responders and 85 partial responders. At day 42, 116 patients (38.9%) responded to treatment, including 61 complete responders and 55 partial responders.
Two hundred fifteen patients (71.2%) had complete day 10 QOL data, 187 of whom also had complete data at day 42. The three most common primary sites of cancer among patients who reported pain at day 42 were prostate (n = 54), breast (n = 51) and lung (n = 43).
From baseline to day 10, responders experienced a greater reduction in pain (mean reduction, 17 vs. 1.8; P = .002) and in pain characteristics (mean reduction, 12.8 vs. 1.1; P = .002) compared with nonresponders. Responders also experienced greater improvements in functional interference (mean increase, 11.6 vs. 3.6; P = .01) and psychosocial aspects (mean increase, 1.2 points vs. mean decrease, 2.2 points; P = .04).
From baseline to day 42, responders had greater improvements on the QLQ-C15-PAL in physical domains (mean increase, 6.2 vs. –9; P < .001), emotional domains (mean increase, 12.3 vs. –5.5; P <.001) and global domains (mean increase, 10.3 vs. –4.5; P < .001) compared with nonresponders. Responders also had significantly greater improvements in the domains of painful sites (59 vs. 31; P = .004), pain characteristics (74 vs. 44; P = .003), functional interference (66 vs. 38; P = .006) and psychosocial aspects (43 vs. 23; P = .03) on the QLQ-BM22.
“Our evaluation time points should be used in future studies that involve similar patient populations because they are more relevant than evaluating those with poor expected survival at 2 or even 3 months after treatment,” McDonald and colleagues wrote.
The results of the analysis may be beneficial to patients with advanced disease, Charles R. Thomas Jr., MD, from the department of radiation medicine, Oregon Health Sciences University, wrote in an editor’s note.
“The current study is a step forward from an earlier study that found early pain relief because all patients in the NCIC CTG SC.23 received the same 8-Gy single-fraction [external beam radiotherapy],” Thomas Jr. wrote. “Early pain relief may be a surrogate de facto marker of future short-term improved QOL. In fact, the current trial may be immediately beneficial to patients with advanced disease and their respective caregivers and healthcare practitioners.” – by Melinda Stevens
Disclosures: The researchers and Thomas Jr. report no relevant financial disclosures.