title: Single Fraction versus Multiple Fraction Radiotherapy for Palliation of Painful Vertebral Bone Metastases: A Prospective Study.
abstract: BACKGROUND
  Metastatic bone disease is a commonly encountered problem in oncology practice. The most useful and cost effective treatment is radiotherapy (RT). Different fractionation schedule of RT can be used to treat such condition.
  
  
  OBJECTIVE
  Assessment of pain response in patients with vertebral bone metastasis after treating them with various radiation fractionations and to compare the toxicity profile in the treatment arms.
  
  
  METHODS
  A prospective randomized study was designed to include total 64 patients from July 2010 to May 2011. Patients with histopathologically proven primary malignancy having symptomatic secondary deposits to vertebra were selected for the study. Patients were randomized to two arms receiving multiple fraction of RT with 30 Gy in 10 fractions and 8 Gy in single fraction RT, respectively.
  
  
  METHODS
  Patients with age >75 years, Karnofsky Performance Status (KPS) <40, features of cord compression were excluded from study. Initial pain response was assessed using Visual Analogue Scale (VAS) and compared using the same scale at weekly interval up to 1 month after treatment completion.
  
  
  RESULTS
  Arm A comprised of 33 patients while 31 patients were enrolled in Arm B. Baseline patient characteristics were comparable. Eleven patients were lost to follow-up. Initial pain scores were 7.23 ± 0.765 and 7.51 ± 0.55 in arm A and arm B, respectively. Pain scores reduced significantly in both the arms after 1 month (4.39 ± 1.82 in arm A; 5.25 ± 2.39 in arm B). Time of initiation of pain response was earlier in arm A (P = 0.0281), statistically significant. Mild G-I toxicity was noted in both the arms but differences in two arms were not statistically significant (P = 0.49), no interruption of treatment was required because of side effects.
  
  
  CONCLUSIONS
  Different fractionation of radiation has same response and toxicity in treatment of vertebral bone metastasis. Single fraction RT may be safely used to treat these cases as this is more cost effective and less time consuming. Studies may be conducted to find out particular subgroup of patients to be benefitted more by either fractionation schedule; however, our study cannot comment on that issue.
authors: Department of Radiotherapy, Palliative Care Unit, Medical College Kolkata, West Bengal University of Health Sciences, Kolkata, West Bengal, India.
authors: Dipanjan
authors: D
authors: Majumder
authors: Debashis
authors: D
authors: Chatterjee
authors: Anis
authors: A
authors: Bandyopadhyay
authors: Swapan Kumar
authors: SK
authors: Mallick
authors: Shyamal Kumar
authors: SK
authors: Sarkar
authors: Anjali
authors: A
authors: Majumdar
keywords: G-I toxicity; Multiple fraction of radiotherapy; Pain scores; Single fraction of radiotherapy; Vertebral bone metastasis