title: Multifraction radiotherapy for palliation of painful bone metastases: 20 Gy versus 30 Gy.
abstract: OBJECTIVE
  To compare 2 multifraction radiotherapy schedules in the palliation of painful bone metastases.
  
  
  METHODS
  We retrospectively analyzed clinical data of 105 patients with a total of 140 painful bone metastases who were treated with 20 Gy in 5 fractions or 30 Gy in 10 fractions. The primary tumors were breast (30%), lung (28%), and prostate (14%). The main sites of irradiation were spine (n = 79) and sacrum or pelvis (n = 39). Pain was graded by patients according to the pain numeric rating scale just before and 1 month after radiotherapy. Pain progression was defined as an increase ≥2 on pain scale after an initial response.
  
  
  RESULTS
  The overall response rate at 1 month was 88.6%. Overall response rate was 89.6% in the 20-Gy arm and 87.3% in the 30-Gy arm (p = 0.669). The rate of complete response was statistically better in patients treated with 30 Gy (p = 0.019). The mean reduction in pain was 3.2 in the 20-Gy group and 3.6 in the 30-Gy group. Pain progression was 6.5% and 1.6%, respectively. The incidence of acute toxicity was statistically significantly higher in the 30-Gy arm (23.8%) than in the 20-Gy arm (2.6%) (p = 0.001). One pathologic fracture of the irradiated bone was observed in the 30-Gy arm. Two lesions, one in each group, were re-irradiated for pain recurrence. Pain progression was found in 6.5% of the irradiated lesions in the 20-Gy arm and in 1.6% in the 30-Gy arm.
  
  
  CONCLUSIONS
  In our series, both regimens achieved high rate of pain relief, although the group treated with higher total dose reported better complete response rate. The 30-Gy arm had a significantly higher rate of acute toxicity.
authors.affiliation: 1Department of Radiation Oncology, Sant'Andrea Hospital, University "Sapienza", Rome - Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Valeriani
authors.forename: Claudia
authors.initials: C
authors.lastname: Scaringi
authors.forename: Luciana
authors.initials: L
authors.lastname: Blasi
authors.forename: Alessia
authors.initials: A
authors.lastname: Carnevale
authors.forename: Vitaliana
authors.initials: V
authors.lastname: De Sanctis
authors.forename: Paolo
authors.initials: P
authors.lastname: Bonome
authors.forename: Stefano
authors.initials: S
authors.lastname: Bracci
authors.forename: Gianluca
authors.initials: G
authors.lastname: Marrone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Minniti
authors.forename: Riccardo Maurizi
authors.initials: RM
authors.lastname: Enrici
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000556:secondary*; D016009:Chi-Square Distribution; D019583:Dose Fractionation, Radiation; D005260:Female; D005598:Fractures, Spontaneous / Q000150:complications* / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome