[Remineralization and pain relief in bone metastases after after different radiotherapy fractions (10 times 3 Gy vs. 1 time 8 Gy). A prospective study].
BACKGROUND
In a prospective randomized trial we examined pain relief and recalcification following radiotherapy for bone metastases.


METHODS
One hundred and seven patients with histologically proven breast, lung, prostate or kidney cancer and radiologically confirmed bone metastases were included in this trial. They were stratified to primary tumor sites and randomized in 2 different fractionation schedules: 1 x 8 Gy vs 10 x 3 Gy. Pain relief was registered using of pain score, analgesic usage and subjective perception of pain. The recalcification was measured at the computertomograph. Pain status and recalcification were assessed before, day after, 6 weeks, 3 and 6 months after radiotherapy.


RESULTS
There was no significant difference in overall (81% vs 78%) and complete (33% vs 31%) pain response. In the single dose group (1 x 8 Gy) the pain response was measured a little rarer. The recalcification showed a significant difference between patients in the fractionated group (173%) and the single dose group (120%, p < 0.0001). In the fractionated group there was a significant difference between patients with breast and lung cancer (p = 0.015). There was a slight trend favoring 10 x 3 Gy in recalcification for all primary tumor sites but only a significant difference in breast cancer (p < 0.001).


CONCLUSIONS
The basis of pain response and recalcification is different. In mere consideration of pain a short-course fractionation is recommendable. This fractionation schedule is effective, well tolerable and short. In consideration of recalcification a more fractionated schedule is recommendable because the biological efficacy is higher and this leads to better stabilisation.
Koswig
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S
Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Charité, Humboldt-Universität Berlin. Koswig@rrk-berlin.de
Budach
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D000328:Adult; D000368:Aged; D015519:Bone Density / Q000528:radiation effects*; D001859:Bone Neoplasms / Q000532:radiotherapy / Q000556:secondary*; D001861:Bone Regeneration / Q000528:radiation effects*; D001943:Breast Neoplasms / Q000532:radiotherapy; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000532:radiotherapy; D008175:Lung Neoplasms / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy