title: Prospective patient-based assessment of effectiveness of palliative radiotherapy for bone metastases.
abstract: OBJECTIVE
  The primary objective of this report is to prospectively evaluate pain control provided by palliative radiotherapy for all irradiated patients with bone metastases by using their own assessments.
  
  
  METHODS
  A prospective database was set up for all patients referred for palliative radiotherapy for bone metastases. Patients were asked to rate their pain intensity using an 11 categorical point scale (0=lack of pain, 10=worst pain imaginable). Analgesic consumption during the preceding 24 h was recorded and converted into equivalent total daily dose of oral morphine. For those who received radiotherapy, follow-up was conducted via telephone interviews at week 1, 2, 4, 8 and 12 post treatment using the same pain scale and analgesic diary. Radiotherapy outcome was initially assessed by pain score alone. Complete response (CR) was defined as a pain score of 0. Partial response (PR) was defined as a reduction of score > or =2 or a> or =50% reduction of the pre-treatment pain score. We further analyzed outcomes using integrated pain and analgesic scores. Response was defined as either a reduction of pain score > or =2 with at least no increase in analgesics or at least stable pain score with a > or =50% reduction in analgesic intake.
  
  
  RESULTS
  One hundred and five patients were treated with palliative radiotherapy. When response evaluation was by pain score alone, the PR rates at 2, 4, 8 and 12 weeks were 44, 42, 30 and 38%, respectively; while the CR rates were 24, 32, 31 and 29%, respectively. The overall response rate at 12 weeks was 67%. When assessed by the integrated pain and analgesic scores, the response rates were 50, 46, 43 and 43%, respectively.
  
  
  CONCLUSIONS
  The response rate in our patient population is comparable with those reported in clinical trials. This is important when counselling our patients on the expected effectiveness of radiotherapy outside of clinical trials. Our observations confirm the generalizability of the trials conducted to date. While randomized trials still remain the gold standard of research, observational studies can serve as useful adjuncts to randomized trials to confirm the efficacy and guide the design of new controlled trials.
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, 2075 Bayview Avenue, M4N 3M5, Toronto, ON, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Chow
authors.forename: R
authors.initials: R
authors.lastname: Wong
authors.forename: G
authors.initials: G
authors.lastname: Hruby
authors.forename: R
authors.initials: R
authors.lastname: Connolly
authors.forename: E
authors.initials: E
authors.lastname: Franssen
authors.forename: K W
authors.initials: KW
authors.lastname: Fung
authors.forename: L
authors.initials: L
authors.lastname: Andersson
authors.forename: T
authors.initials: T
authors.lastname: Schueller
authors.forename: K
authors.initials: K
authors.lastname: Stefaniuk
authors.forename: E
authors.initials: E
authors.lastname: Szumacher
authors.forename: C
authors.initials: C
authors.lastname: Hayter
authors.forename: J
authors.initials: J
authors.lastname: Pope
authors.forename: L
authors.initials: L
authors.lastname: Holden
authors.forename: A
authors.initials: A
authors.lastname: Loblaw
authors.forename: J
authors.initials: J
authors.lastname: Finkelstein
authors.forename: C
authors.initials: C
authors.lastname: Danjoux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000517:prevention & control*; D010166:Palliative Care; D011446:Prospective Studies