Single radiotherapy session effective for bone metastases pain

Patients who received standard radiation treatments had significantly higher rates of acute toxicity.

A single treatment session of 8 Gy of radiation appears to be as effective for reducing pain from bone metastases as 10 daily treatments of 30 Gy, according to a new study.

Ten daily sessions of 30 Gy of radiation is the current treatment standard in the United States. It generally reduces pain in 50% to 80% of patients, with 20% to 50% of patients receiving complete pain relief. However, a shorter treatment course would be easier for patients and their families to complete. It would also have less of an impact on timing other treatments, according to a press release.

William F. Hartsell, MD, a radiation oncologist at the Lutheran General Cancer Center in Park Ridge, Ill., prospectively compared the two treatment regimens with colleagues at several U.S. institutions. The study included patients with breast or prostate cancer and up to three sites of bone metastases. The researchers randomly assigned 455 patients to treatment with a single session of 8 Gy of radiation and 443 patients to treatment with 10 daily sessions of 30 Gy of radiation. They published their results in the Journal of the National Cancer Institute.

At three months follow-up, the researchers found that both treatment regimens provided equal pain relief. Both groups also had similar rates of subsequent pathologic fractures, according to the study.

Overall, 66% of patients responded to their treatment regimen. Among patients in the 8 Gy radiation group, 15% had a complete treatment response and 50% had a partial treatment response. Comparatively, 18% of patients in the 30 Gy radiation group had a complete treatment response and 48% had a partial response.

At three months follow-up, 33% of patients no longer required narcotic medication to relieve pain, the authors noted.

Patients in the 8 Gy radiation group did have a significantly higher retreatment rate — 18% vs. 9% for patients in the 30 Gy radiation group (P<.001). Patients in the 8 Gy radiation group had a significantly lower incidence of acute toxicity, however. The researchers noted acute toxicity of grade two to grade four among 10% of 8 Gy patients and among 17% of 30 Gy patients (P=.002), according to the study.

“Further analysis of data from [this] trial should yield important information on quality of life, health utilities (ie, patient preferences for specific health states or treatments), and economic end points,” the authors said. “These data will help determine whether a single dose of 8 Gy should become the standard treatment for palliation of localized painful bone metastases,” they added.

For more information:
Hartsell WF, Scott CB, Bruner DW, et al. Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst. 2005;97:798-804.