A Single Dose of Radiation Therapy Is Very Effective in Easing the Pain of Bone Metastases
Cancer Treatment and Radiation Therapy
A single radiation therapy treatment provides very effective relief for breast and prostate cancer patients who suffer from painful bone metastases, reports a study by the Radiation Therapy Oncology Group (RTOG) in the June 1 issue of the Journal of the National Cancer Institute. The publication details the results of a national multicenter trial that prospectively randomized patients with painful bone metastases from breast or prostate cancer to receive either a single high dose of radiation therapy or ten smaller doses given over two weeks. The RTOG authors concluded that a single high dose of radiation therapy is just as effective in reducing pain and the associated use of pain-killing drugs as the longer treatment course with smaller daily does. RTOG is a clinical research enterprise component of the American College of Radiology (ACR).
"This is an important and large randomized study demonstrating that a short course of radiation or one large treatment for bone metastases from prostate or breast cancer is equally effective to a longer (two-week) course. This will help patients by reducing the time spent receiving palliative radiation," says Benjamin Movsas, M.D., chair of Radiation Oncology at Henry Ford Hospital. "At Henry Ford, we have pioneered a novel technique to deliver a more intensive dose of radiation in one treatment utilizing stereotactic or highly focused radiation for patients with spine metastases," he adds.
RTOG member hospitals and universities in the United States and Canada participated in the study together with the member institutions of the North Central Cancer Treatment Group (NCCTG). Between 1998 and 2001 a total of 949 patients were enrolled in the study, of which 898 were considered eligible. The patients were randomized to receive either a single 8 Gy dose of radiation therapy or 10 doses of 3 Gy each over 10 days. The two arms were evenly divided between women with breast cancer and men with prostate cancer and patient pre-treatment characteristics were equally balanced between the two treatment arms. All patients had moderate to severe pain, radiographic evidence of bone metastases at a painful site, a life expectancy of more than 3 months, no prior surgery or palliative external beam radiation therapy to that site and no change in their cancer therapy for 30 days.
Patients on both treatment arms had equivalent pain relief with 33% of all patients no longer needing pain-killing narcotics at three months. Pain relief was also measured by patient-completed self-assessment instruments. Complete relief from pain was seen in 15% of the patients on the single dose arm and 18% of the patients on the longer course arm while 50% of the patients on the single dose arm and 48% of those on the longer course arm reported partial pain relief.
The manuscript, Randomized Trial of Short- Versus Long-Course Radiotherapy for Palliation of Painful Bone Metastases, was published in the June 1, 2005 edition of the Journal of the National Cancer Institute, vol. 97, no. 11, pgs 798-804. The independent study was coordinated by the Radiation Therapy Oncology Group (RTOG), with participation from its member institutions and the member institutions of the North Central Cancer Treatment Group (NCCTG). The National Cancer Institute provided financial support for the study.