8 Gy single fraction radiotherapy for the treatment of metastatic skeletalpain: randomised comparison with a multifraction schedule over 12 months of patient follow-up

Citation
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
Citations number
10
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Onconogenesis & Cancer Research
Journal title
RADIOTHERAPY AND ONCOLOGY
ISSN journal
0167-8140 → ACNP
Volume
52
Issue
2
Year of publication
1999
Pages
111 - 121
Database
ISI
SICI code
0167-8140(199908)52:2<111:8GSFRF>2.0.ZU;2-I
Abstract
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.