Palliative radiotherapy of bone metastases. A retrospective analysis of 176 patients

Background: The effect of the palliative irradiation of bone metastases was explored in this retrospective analysis. The spectrum of primary tumor sit es, the localization of the bone metastases and the fractionation schedules were analyzed with regard to palliation discriminating total, partial and complete pain response. Patients and Methods: One hundred seventy-six patients are included in this retrospective quantitative study from April 1992 to November 1993. Two hun dred fifty-eight localizations of painful bone metastases were irradiated. The percentage of bone metastases of the total irradiated localizations in our department of radiotherapy in the Charite-Hospital, the primary tumor s ites, the localizations and the different fractionation schedules were expl ored. The total, partial and complete pain response was analyzed in the mos t often used fractionation schedules and by primary tumor sites. Results: Eight per cent of all irradiated localizations in the observation period were bone metastases. There were irradiated bone metastases of 21 di fferent tumor sites. Most of the primary tumor sites were breast cancer (49 %), lung cancer (6%) and kidney cancer (6%). The most frequent site of meta stases was the vertebral column (52%). The most often used fractionation sc hedules were: 4 x 5 Gy (32%), 10 x 3 Gy (18%), 6 x 5 Gy (9%), 7 x 3 Gy (7%) , 10 x 2 Gy (5%) and 2 x 8 Gy. The total response rates in this fractionati on schedules were 72%, 79%, 74%, 76%, 75% and 72%, the complete response ra tes were 35%, 32%, 30%, 35%, 33% and 33%. There were no significant differe nces between the most often irradiated primary tumor sites, the mast freque nt localizations and the palliation with regard to-total, partial and compl ete pain response. Conclusion: There are no differences between the different fractionation sc hedules with regard to the pain effect of bone metastases. A palliation is ensured in 75% of all cases with a partial response of 42% and complete res ponse of 33%. With regard to pain response these results do not justify a r ecommendation for a standard fractionation schedule. Current fractionation schedules such as 10 x 3 Cy for 2 weeks or 5 x 4 Gy for 1 week should be us ed. Another point is the recalcification in the palliative treatment of bon e metastases in patients with better prognosis. The recalcification is the basis for stabilization and prevention of fractures. This aspect should be explored in prospective studies.