Eenmalige bestraling van pijnlijke botmetastasen even effectief als meervoudige bestraling. Uitkomsten van de 'Nederlandse botmetastasenstudie'

To determine whether a single fraction of radiotherapy is as effective as multiple fractions for the palliation of painful bone metastases.

Design

Prospective, randomised, open.

Patients and method

In the period from 1 March 1996 to 31 August 1998, patients with painful bone metastases were randomised between 1 fraction of 8 Gy (on 1 day) and 6 fractions of 4 Gy (during 1,5 week). Frequent questionnaires were mailed to them to collect information on pain, consumption of analgesics, side effects and quality of life, and regarding matters from which the medical and other costs could be derived. Pain response was defined as a decrease of at least two points compared to the initial pain score (on a scale from 0 = no pain to 10 = the worst imaginable pain). If the pain score decreased to 0 or 1, this was interpreted as a complete response.

Results

Of the 1157 patients treated (624 men and 533 women with an age range of 32-89 years), 579 received a single dose and 578 received 6 fractions. The primary tumour was mammary carcinoma in 39, carcinoma of the prostate in 23, pulmonary carcinoma in 25 and others in 13. Metastases were found in the spinal column (30), pelvis (36), femur (10), ribs (8), humerus (6) and other sites (10). Overall, 71 patients achieved a pain response and 35 a complete pain response. There was no difference between the two treatment groups in pain reduction. There was also no difference between the two groups with regard to the use of analgesics, side effects and overall quality of life. Single-dose irradiation was less expensive than repeated irradiation (6855-5078 = 1777 euros).

Conclusion

Single-dose radiotherapy is as effective as fractionated radiotherapy in the treatment of painful bone metastases, while it is less expensive and is not accompanied by any more side effects.