RAPID COURSE RADIATION-THERAPY VS, MORE STANDARD TREATMENT - A RANDOMIZED TRIAL FOR BONE METASTASES

Purpose: In a prospective randomized trial we examined whether radioth erapy of painful bone metastases can be shortened using larger single doses without impairing effectivity. Methods and Materials: One hundre d patients with painful bone metastases having no prior surgical inter vention or treatment with x-ray therapy and had a median follow-up of 12 months were analyzed. The primary tumor was located in the breast i n 43%, in the lung in 24%, and in the prostate in 14%. The most freque nt sites of metastases were the pelvis (31%), the vertebral column (30 %), and the ribs (20%). Further percentages of sites were: lower extre mity 11%, upper extremity 6%, and skull 2%. Fifty-one patients receive d a short course radiotherapy with a total dose of 20 Gy in 1 week (da ily dose 4 Gy), and 49 patients received 30 Gy in 3 weeks (daily dose 2 Gy). Results: There were no significant differences in frequency, du ration of pain relief, improvement of mobility, recalcification, frequ ency of pathologic fractures nor survival. There was a light trend fav oring 30 Gy in frequency of pain relief and recalcification. Survival was mostly influenced by primary tumor site, Karnofsky performance sta tus, and possibly by the response to radiotherapy (pain relief). Concl usions: Because of the very short life expectancy of patients with met astatic bone disease, we now use 20 Gy in 1 week as our standard to re duce hospital stay. Copyright (C) 1996 Elsevier Science Inc.