Purpose: External beam radiotherapy is an effective treatment for symptomatic bone metastases. This study aims to compare the 8Gy in single fraction and 30Gy in 10 fractions radiotherapy for palliation of bone metastases in terms of pain relieving efficacy, toxicity and feasibility of different dose schedules.

Material and Method: In this two arm, prospective comparative study we enrolled 60 patients of  ≥18 years with KPS ≥ 40, histologically proven malignancy with radiologically confirmed, painful bone metastases and randomized (1:1) to receive either 8 Gy in a single fraction or 30 Gy in 10 fractions with Zoledronic acid every 4 weeks for 6 months. Treatment response was determined by Brief Pain Inventory and toxicity assessment was done by CTCAE version 4.03.

Results: Overall response was 76.6% in both groups. In 8Gy group complete response and partial response were 36.7% and 40% respectively compared with 30% and 46.7% in 30 Gy group respectively (p =0.76). In both arms frequently reported toxicities were anorexia and anemia. No grade 4-5 toxicity were reported in any patient. Retreatment rate were higher in 8 Gy group than 30 Gy group (10% vs 3.3%, p = 0.61).

Conclusion: 8Gy/1 fraction is as effective as 30Gy/10 fraction for palliation of painful bone metastasis with less side effects and more feasible for patients and caregivers in terms of treatment duration, cost and hospital visit.

Keywords: Painful bone metastasis, Zoledronic acid, radiotherapy, single fraction.

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Dr. Sanandan Patel

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