A. Ashton et al., 8 Gy single fraction radiotherapy for the treatment of metastatic skeletalpain: randomised comparison with a multifraction schedule over 12 months of patient follow-up, RADIOTH ONC, 52(2), 1999, pp. 111-121
Radiology ,Nuclear Medicine & Imaging","Onconogenesis & Cancer Research
Aim: To compare a single fraction of 8 Gy with a course of multifraction ra
diotherapy in terms of long-term benefits and short-term side effects in pa
tients with painful skeletal metastases.
Methods: Seven hundred and sixty-five patients with painful skeletal metast
ases requiring palliative radiotherapy were entered into a prospective rand
omised clinical trial comparing 8 Gy single fraction with a multifraction r
egimen (20 Gy/5 fractions or 30 Gy/10 fractions). Patients recorded pain se
verity and analgesic requirements on self-assessment questionnaires before
treatment, at 2 weeks and at 1,2, 3, 4, 5, 6, 8, 10 and 12 months after rad
iotherapy. Pain relief was the primary endpoint of treatment benefit. Short
-term side-effects were compared in a subset of 133 consecutive patients wh
o graded nausea, vomiting and antiemetic usage prior to treatment and at da
ily intervals from days 1 to 14.
Results: Overall survival at 12 months was 44%, with no statistically signi
ficant difference apparent between randomised groups. There were no differe
nces in the time to first improvement in pain, time to complete pain relief
or in time to first increase in pain at any time up to 12 months from rand
omisation, nor in the class of analgesic used. Retreatment was twice as com
mon after 8 Gy than after multifraction radiotherapy, although retreatment
for residual or recurrent pain did not reflect a difference between randomi
sed groups in the probability of pain relief. The difference in the rate of
retreatment is thought to reflect a greater readiness to prescribe radioth
erapy after a single fraction, not a greater need. There were no significan
t differences in the incidence of nausea, vomiting, spinal cord compression
or pathological fracture between the two groups.
Conclusions: A single fraction of 8 Gy is as safe and effective as a multif
raction regimen for the palliation of metastatic bone pain for at least 12
months. The greater convenience and lower cost make 8 Gy single fraction th
e treatment of choice for the majority of patients. (C) 1999 Elsevier Scien
ce Ireland Ltd. All rights reserved.