Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-19T00:34:00.592Z Has data issue: false hasContentIssue false
  • English
  • Français

Palliative radiotherapy for bone metastases: assessment of factors influencing dose-fractionation schedules at a UK cancer centre

Published online by Cambridge University Press:  16 May 2013

N. Bhalla ,
H. Wong ,
A. Ibrahim  and
J. A. Green
N. Bhalla*
Affiliation:
Clatterbridge Centre for Oncology, NHS Foundation Trust, Bebington, UK
H. Wong
Affiliation:
Clatterbridge Centre for Oncology, NHS Foundation Trust, Bebington, UK
A. Ibrahim
Affiliation:
Clatterbridge Centre for Oncology, NHS Foundation Trust, Bebington, UK
J. A. Green
Affiliation:
Clatterbridge Centre for Oncology, NHS Foundation Trust, Bebington, UK
*
Correspondence to: Neeraj Bhalla, Clatterbridge Cancer Centre, Bebington, Wirral CH63 4JY, UK. Tel: 0151 334 1155. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Context

Meta-analyses demonstrate single-fraction radiotherapy to be as effective as multi-fraction treatment in palliating painful bone metastases, although surveys suggest reluctance in prescribing single fractions.

Aims

Assess the factors influencing the choice of dose-fractionation regimen in an unselected population; examine retreatment rates and subsequent skeletal events.

Methods

Data were extracted from case notes for 120 patients treated in 2000 and 2006 in a single centre serving a defined population; analysis used χ2 and Fisher's exact statistical tests.

Results

An 8 Gy fraction was the commonest regimen prescribed (single-fraction delivery rate 53·6%). Tumour site was a significant factor in choice of dose-fractionation schedule. Patients with metastatic breast carcinoma were significantly less likely to receive single-fraction treatment compared with those with metastatic lung carcinoma (year 2000: p = 0·038, 2006: p = 0·001). There was a significantly higher retreatment rate following single-fraction compared with multi-fraction treatment (11% versus 3%). There were two subsequent neural axis compressions and four pathological fractures.

Conclusions

Single-fraction treatment is the commonest regimen but multiple fractions are still frequently delivered. Better prognosis groups appear more likely to receive multi-fraction treatment, possibly to avoid the need for retreatment. Subsequent skeletal events are rare but carry high morbidity when they occur.

Keywords

adverse skeletal eventsbone metastasesdose-fractionationpainpalliationradiotherapy
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 12 , Issue 3 , September 2013 , pp. 208 - 217
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Chow, E, Harris, K, Fan, G, Tsoa, M, Sze, W M. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol 2007; 25 (11): 1423–1436.CrossRefGoogle ScholarPubMed
2.Agarwal, J P, Swangsilpa, T, van der Linden, Y, Rades, D, Jeremic, B, Hoskin, P J. The role of external beam radiotherapy in the management of bone metastases. Clin Oncol 2006; 18: 747–760.CrossRefGoogle Scholar
3.Tong, D, Gillick, L, Hendrickson, F R. The palliation of symptomatic osseous metastases. Final results of the study by the Radiation Therapy Oncology Group. Cancer 1982; 50: 893–899.3.0.CO;2-Y>CrossRefGoogle Scholar
4.Price, P, Hoskin, P J, Easton, Det al. Prospective randomised trial of single and multifraction radiotherapy schedules in the treatment of painful bony metastases. Radiother Oncol 1986; 6: 247–255.CrossRefGoogle ScholarPubMed
5.Cole, D J. A randomised trial of a single treatment versus conventional fractionation in the palliative radiotherapy of painful bone metastases. Clin Oncol 1989; 1: 59–62.CrossRefGoogle ScholarPubMed
6.Hoskin, P J, Price, P, Easton, Det al. A prospective randomised trial of 4 Gy or 8 Gy single doses on the treatment of metastatic bone pain. Radiother Oncol 1992; 22: 74–78.CrossRefGoogle Scholar
7.Gaze, M N, Kelly, C G, Kerr, G Ret al. Pain relief and quality of life following radiotherapy for bone metastases: a randomised trial of two fractionation schedules. Radiother Oncol 1997; 45: 109–116.CrossRefGoogle ScholarPubMed
8.Koswig, S, Budach, V. Remineralization and pain relief in bone metastases after different radiotherapy fractions (10 times 3 Gy vs. 1 time 8 Gy). Strahlenther Onkol 1999; 175: 500–508.CrossRefGoogle Scholar
9.Steenland, E, Leer, J W, van Houwelingen, Het al. The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study. Radiother Oncol 1999; 52: 101–109.CrossRefGoogle ScholarPubMed
10.Bone Pain Trial Working Party. 8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomised comparison with a multifraction schedule over 12 months of patient follow-up. Radiother Oncol 1999; 52: 111–121.CrossRefGoogle Scholar
11.Kirkbride, P, Warde, P, Panzarella, Aet al. A randomised trial comparing the efficacy of single fraction radiation therapy plus ondansetron with fractionated radiation therapy in the palliation of skeletal metastases (Abstract). Int J Radiat Oncol Biol Phys 2000; 48 (suppl 3): 185.CrossRefGoogle Scholar
12.Hartsell, W F, Scott, C B, Watkins Bruner, Det al. Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst 2005; 97: 798–804.CrossRefGoogle ScholarPubMed
13.Ratanatharathorn, V, Powers, W E, Moss, W T, Perez, C A. Bone metastasis: review and critical analysis of random allocation trials of local field treatment. Int J Radiation Oncology Biol Phys 1999; 44: 1–18.CrossRefGoogle ScholarPubMed
14.McQuay, H J, Carroll, D, Moore, R A. Radiotherapy for painful bone metastases: a systematic review. Clin Oncol 1997; 9: 150–154.CrossRefGoogle ScholarPubMed
15.Wu, JS, Wong, R, Johnston, M, Bezjak, A, Whelan, T. Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiation Oncology Biol Phys 2003; 55 (3): 594–605.CrossRefGoogle ScholarPubMed
16.Sze, W, Shelley, M D, Held, I, wilt, T J, Mason, M D. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy—a systematic review of randomised trials. Clin Oncol 2003; 15: 345–352.CrossRefGoogle ScholarPubMed
17.Chow, E, Danjoux, C, Wong, Ret al. Palliation of bone metastases: a survey of patterns of practice among Canadian radiation oncologists. Radiother Oncol 2000; 52: 305–314.CrossRefGoogle Scholar
18.Hartsell, W, Shah, A, Graney, M, Kun, L. Palliation of bone metastases in the USA: a survey of patterns of practice. (abstract) Support Care Cancer 1998; 6 (2): 175.Google Scholar
19.Fairchild, A, Barnes, E, Ghosh, Set al. International patterns of practice in palliative radiotherapy for painful bone metastases: evidence-based practice? Int J Radiat Oncol Biol Phys 2009; 75 (5): 1501–1510.CrossRefGoogle ScholarPubMed
20.van der Linden, Y, Roos, D, Lutz, S, Fairchild, A. International variations in radiotherapy fractionation for bone metastases: geographic borders define practice patterns? Clin Oncol 2009; 9: 655–658.CrossRefGoogle Scholar
21. Royal College of Radiologists Audit Single Fraction Radiotherapy for Bone Metastases Royal College of Radiologists Audit (Faculty of Clinical Oncology), London, 2007.Google Scholar
22.Lutz, S T, Berk, L, Chang, Eet al. Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys 2011; 79 (4): 965–976.CrossRefGoogle ScholarPubMed
23. Merseyside and Cheshire Cancer Network. http://www.mccn.nhs.uk. Accessed on 4 September 2011.Google Scholar
24.Hall, E J. Radiobiology for the radiologist, 5th edition. Philadelphia, USA: Lippincott Williams and Wilkins, 2000.Google Scholar
25. Common Terminology Criteria for Adverse Events v3·0 (CTCAE). USA: National Cancer Institute, 2006.Google Scholar
26. Royal College of Radiologists, Radiotherapy Dose-Fractionation, Royal College of Radiologists (Faculty of Clinical Oncology), London, 2006.Google Scholar
27.Roos, E. Continuing reluctance to use single fractions of radiotherapy for metastatic bone pain: an Australian and New Zealand practice survey and literature review. Radiother Oncol 2000; 56: 313–320.CrossRefGoogle ScholarPubMed
28.National Cancer Institute, Surveillance Epidemiology and End Results. http://www.seer.cancer.gov/statfacts. Accessed on 18 September 2011.Google Scholar
29.Roos, D E, Turner, S L, O'Brien, P Cet al. Randomised trial of 8 Gy in 1 versus 20 Gy in 5 fractions of radiotherapy for neuropathic pain due to bone metastases. Radiother Oncol 2005; 75: 54–63.CrossRefGoogle ScholarPubMed
30.Coia, L R, Owen, J B, Maher, E J, Hanks, G E. Factors affecting treatment patterns of radiation oncologists in the United States in the palliative treatment of cancer. Clin Oncol 1992; 4: 6–10.CrossRefGoogle ScholarPubMed
31.Chow, E, Wu, J, Hoskin, Pet al. International consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases. Radiother Oncol 2002; 64: 275–280.CrossRefGoogle ScholarPubMed