Title: Single Fraction versus Multi Fraction Radiotherapy Treatment Schedules for Management of Painful Bone Metastasis
Authors: Astha Parmar, Maitrik Mehta, Rajan Yadav, Ankita Parikh, U Suryanarayana
DOI: https://dx.doi.org/10.18535/jmscr/v7i4.98
Abstract
Introduction
Bone metastasis is very common in certain solid malignancies. The most common bones to be involved is vertebrae, lumbar vertebrae to be most commonly involved. The incidence of bone metastases varies significantly, depending on the primary site, with breast and prostate cancer accounting for up to 70% of patients with metastatic disease. Bone metastases may be found in up to 85% of patients suffering from breast, prostate, or lung cancer. Other primary sites with a propensity for bone metastases include thyroid, melanoma, and kidney. On the other hand, gastrointestinal sites of primary malignancy give rise to bone metastasis in only 3% to 15% of patients with metastatic disease. Some hematologic malignancies, including myeloma and lymphoma, can also cause significant pain and bone destruction. Patients with bone metastases from lung cancer have short median survival durations of 6 months. However, patients with bone metastases from breast or prostate primary sites may have significantly longer survival times.
Materials and Methods
The review article was compiled by searching PubMed and Medline databases. Electronic early-release publications were also included. The search terms used included ‘bone metastases’, ‘bone metastasis’, ‘metastatic spinal cord compression’, ‘malignant spinal cord compression’, ‘metastatic epidural spinal cord compression’, ‘malignant epidural spinal cord compression’, ‘pathological fracture’. When possible, primary sources were quoted.
Results
Randomized trials and metanalysis demonstrated that single fraction radiotherapy 8 Gy/# is as effective for pain relief as multi fraction regimens such as 20 Gy/5# or 30 Gy/10#. These results have been confirmed by three randomized trials.
Kapoor et al took 250 consecutive patients of bone metastasis for the study. Sixty-two percent of the patients received a single fraction while the remaining received 10 fractions. In the 10-fraction group, overall response was present in 60% of the patients. Stable pain was present in 23% of the patients while 9% patients had progressive pain. In the single-fraction arm, overall response was seen in 58%, stable pain in 27% and progressive pain in 7% of the patients. Six percent of the patients were lost to follow-up.
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