Role of palliative radiotherapy in painful bone metastases: A prospective study

 

Sunigdha¹, Manraj S Kang^2*, Raja PS Banipal³, Pardeep Garg⁴

 

Abstract              Background: Metastatic bone diseases is a usual cause of pain in cancer patients. Bone metastases are associated with skeletal-related events(SREs) including pathological fractures, spinal cord compression, bone pain and hypercalcemia which leads to impaired mobility and reduced quality of life. Radiation therapy plays an important role in the treatment of painful bone metastases. Objectives: To compare the pain relieving efficacy and improvement in quality of life by using 8 Gy in single fraction in one day versus 20 Gy in five fractions in five days in patients with painful bone metastases. Material and Methods: A prospective study conducted on sixty patients with painful bone metastases who were randomly assigned. By using visual analogue score, baseline pain assessment was done at day 1, day 7, day 15, 1 month and 3 months after treatment. WHO analgesic pain ladder was also used for adequate pain relief. Results: Majority of patients were included in age group of 51-60 yrs(46.7%), followed by 61-70 yrs of age group (35%). Majority of the patients were of carcinoma breast(48%), followed by carcinoma prostate(38.3%), followed by multiple myeloma(6.6%). Thoracolumbar spine involvement(68.3%) to be the commonest site of metastases. A reduction in severity of pain was noticed with 28% patients experiencing no pain, 52% having mild pain and only 12% having severe pain after 3 months of treatment in 8Gy in one fraction in day group while in comparison, in 20Gy in 5 fractions in 5 days group, 60% patients experienced no pain and 40% patients had mild pain after 3 months of treatment. The requirement of analgesics dropped in both the arms in comparison to pretreatment analgesics requirement, but after 3 months of follow up it was observed that Arm B required less analgesics as compare to Arm A. Conclusion: Both 8 Gy in single fraction and multi-fractionated regimen are effective to treatment painful metastatic bone disease but 8 Gy in single fraction in one day has greater convenience, lower cost and less duration of hospital stay with same efficacy for palliation of painful bone metastases.

Key Words: Bone metastases, painful, palliative radiotherapy, fractions, multiple.