RANDOMIZED TRIAL OF SINGLE-DOSE VERSUS FRACTIONATED PALLIATIVE RADIOTHERAPY OF BONE METASTASES

Purpose: Data in the literature suggest that for painful bone metastas es a single dose is as effective as fractionated radiotherapy. In the present multicentre prospective trial, the effects of 8 Gy x1 and 5 Gy x4 were compared. Patients and methods: A total of 241 patients were randomized to 8 Gy (122 patients) or 20 Gy (119 patients). The primary tumour was in the breast in 39% of patients, in the prostate in 34% o f patients, in the lung in 13% of patients and in other locations in 1 4% of patients. Outcome measures were pain relief as measured by VAS a nd in half of the patients also by a five-point categorical pain scale , global quality of life (QoL) and analgesic consumption. Evaluation w as performed before and 4, 8, 12 and 20 weeks after treatment. Results : A total of 239 patients were evaluable for response. The two groups did not differ with respect to age, sex, primary tumour, metastasis lo calization, analgesic consumption (type and dose), performance status, prior systemic treatment, degree of pain and QoL. The treatment was c ompleted as planned in 98% of patients. The degree of pain relief did not differ between the two treatment groups. At 4 weeks the difference in pain relief was 6% (95% CI 7, 20%) and at 8 weeks the difference w as 13% (95% CI 3, 28%). Neither was there any significant difference i n the duration of pain relief, the number of new painful sites and the need for reirradiation and toxicity was minor. Conclusion: The presen t randomized study showed that a single fraction of 8 Gy was as effect ive as 5 Gy x4 in relieving pain from bone metastasis. (C) 1998 Elsevi er Science Ireland Ltd. All rights reserved.