title: Comparison of single versus multiple fractions for palliative treatment of painful bone metastasis: first study from north west India.
abstract: BACKGROUND
  Bone metastasis is a usual cause of pain in advanced cancer. Conventional radiation schedules require larger hospital stay and thus are not suitable for patients with poor general condition. This prospective observational study aims to compare the pain-relieving efficacy of different radiation fractionation schedules, i.e., 8 Gy administered in a single fraction versus 30 Gy administered in 10 fractions.
  
  
  METHODS
  Two hundred and fifty consecutive patients of bone metastasis were evaluated for the study, with 63 patients being excluded due to non-fulfillment of the inclusion criteria. The response to radiotherapy leading to pain relief as per the Visual Analog Scale was recorded at the end of treatment, 8 days, 15 days and 1 month during the follow-up visits.
  
  
  RESULTS
  Sixty-two percent of the patients received a single fraction while the remaining received 10 fractions. In the 10-fraction group, overall response was present in 60% of the patients. Stable pain was present in 23% of the patients while 9% patients had progressive pain. At 1 month of completion of treatment, 9% patients were lost to follow-up. In the single-fraction arm, overall response was seen in 58%, stable pain in 27% and progressive pain in 7% of the patients. Six percent of the patients were lost to follow-up.
  
  
  CONCLUSIONS
  Single-fraction treatment for bony metastasis is as effective as multiple fractions to relieve bony pain and provides treatment convenience to both the patient and the caregiver.
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Akhil
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Mukesh Kumar
authors.initials: MK
authors.lastname: Singhal
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Puneet Kumar
authors.initials: PK
authors.lastname: Bagri
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Raj Kumar
authors.initials: RK
authors.lastname: Nirban
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Sitaram
authors.initials: S
authors.lastname: Maharia
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Satya
authors.initials: S
authors.lastname: Narayan
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Harvindra Singh
authors.initials: HS
authors.lastname: Kumar
keywords: Bone metastasis; multiple fractions; north west India; palliative radiotherapy; single fraction