title: IAEA randomised trial of optimal single dose radiotherapy in the treatment of painful bone metastases.
abstract: BACKGROUND
  To determine the optimal single-dose radiotherapy schedule for pain from bone metastases in a multi-centre, international, randomised trial.
  
  
  METHODS
  651 patients were randomised to either 8Gy (n=325) or 4Gy (n=326) radiotherapy. Pain at 4, 8, 12, 24 and 52weeks was assessed using a Categorical Scale (CS) and a Visual Analogue Scale (VAS). The primary endpoint was response at 4weeks.
  
  
  RESULTS
  There was no significant difference in patient demographics and other co-variates. The complete response (CR) rate and ORR (complete or partial response) for all follow-up times were higher after 8Gy (p=0.02). The Kaplan-Meier actuarial rate (categorical scale) at 4weeks for ORR was 80% after 8Gy compared to 68% after 4Gy (p=0.0015). 117 re-treatments were given of which 72 were in the 4Gy group and 45 in 8Gy arm (p=0.01).
  
  
  CONCLUSIONS
  There was a marked consistent difference in pain relief at all time points in favour of 8Gy. These data reinforce the case for single dose 8Gy radiotherapy to be recommended for metastatic bone pain in all healthcare settings.
authors.affiliation: Cancer Centre, Mount Vernon Hospital, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Hoskin
authors.affiliation: Cancer Centre, Mount Vernon Hospital, UK. Electronic address: arc03@btconnect.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Rojas
authors.affiliation: IAEA, Division of Human Health, Vienna, Austria.
authors.forename: Elena
authors.initials: E
authors.lastname: Fidarova
authors.affiliation: Tata Memorial Hospital, Mumbai, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Jalali
authors.affiliation: Hospital Son Dureta, Palmas de Mallorca, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Mena Merino
authors.affiliation: Instituto Nacional Cancerología, México DF, Mexico.
authors.forename: Adela
authors.initials: A
authors.lastname: Poitevin
authors.affiliation: Dep. Radiothérapie, Centre Hospitalier Universitaire, Alger, Algeria.
authors.forename: Seam
authors.initials: S
authors.lastname: Oucrif
authors.affiliation: Misr Oncology Centre, Cairo, Egypt.
authors.forename: Sherif
authors.initials: S
authors.lastname: Abdelwahab
authors.affiliation: Radiotherapie carcinologique, Institut Salah Azaiz, Tunis, Tunisia.
authors.forename: Lotfi
authors.initials: L
authors.lastname: Kochbati
authors.affiliation: Institute of Oncology, Vilnius University, Lithuania.
authors.forename: Aista
authors.initials: A
authors.lastname: Plieskiene
authors.affiliation: Radiation Oncology, Hospital Clínic i Universitari, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Casas
authors.affiliation: Institute of Oncology & Radiology, Belgrade, Serbia.
authors.forename: Susana
authors.initials: S
authors.lastname: Stojanovic
authors.affiliation: Fundacao Faculdade Federal de Ciencias Medicas, Porto Alegre, Brazil.
authors.forename: Günther
authors.initials: G
authors.lastname: Schneider
authors.affiliation: IAEA, Division of Human Health, Vienna, Austria.
authors.forename: Branislav
authors.initials: B
authors.lastname: Jeremic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000532:radiotherapy*; D059408:Pain Management; D010147:Pain Measurement; D011879:Radiotherapy Dosage
keywords: Bone metastases; Bone pain; Dose response; Palliative radiotherapy