title: Effect of Radiotherapy on Painful Bone Metastases: A Secondary Analysis of the NCIC Clinical Trials Group Symptom Control Trial SC.23.
abstract: OBJECTIVE
  Many studies that found improved quality of life (QOL) after radiotherapy of bone metastases have small sample sizes and do not use specific questionnaires. How soon after radiotherapy one can expect an improvement in QOL is unknown.
  
  
  OBJECTIVE
  To investigate QOL at days 10 and 42 after radiotherapy with a bone metastases-specific QOL tool.
  
  
  METHODS
  In this secondary analysis of the NCIC Clinical Trials Group Symptom Control Trial SC.23, a double-blind randomized clinical trial that investigated dexamethasone for the prophylaxis of pain flare after radiotherapy, patients were accrued from 23 Canadian centers from May 30, 2011, to December 11, 2014, and were followed up for 42 days after treatment. Participants referred for radiotherapy for bone metastases were required to have a pain score at the site(s) of treatment of at least 2 (range, 0-10).
  
  
  METHODS
  Patients were treated with a single 8-Gy radiotherapy dose for 1 or 2 bone metastases.
  
  
  METHODS
  Patients reported their worst pain score and analgesic intake at baseline and days 10 and 42 after treatment. Pain response was assessed with International Bone Metastases Consensus Endpoint Definitions. Self-reported QOL was completed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Bone Metastases Module (QLQ-BM22) and the European Organisation for Research and Treatment of Cancer Quality of Life Core 15 Palliative (QLQ-C15-PAL) at the same time points.
  
  
  RESULTS
  A total of 298 patients were accrued (median age, 68.8 [range, 32-94] years at day 10 and 68.0 [range, 34-90] years at day 42). A total of 122 patients (40.9%) responded to radiotherapy at day 10 and 116 patients (38.9%) at day 42. At day 10, compared with nonresponders, patients with a pain response had a greater reduction in pain (mean reduction, 17.0 vs 1.8; P = .002) and pain characteristics (mean reduction, 12.8 vs 1.1; P = .002), as well as greater improvements in functional interference (mean increase, 11.6 vs 3.6; P = .01) and psychosocial aspects (mean increase, 1.2 points in responders vs mean decrease of 2.2 points in nonresponders, P = .04). Comparing changes in QOL from baseline to day 42, responders had significantly greater improvements in the physical (mean increase, 6.2 vs -9.0; P < .001), emotional (mean increase, 12.3 vs -5.5; P < .001), and global domains (mean increase, 10.3 vs -4.5; P < .001) of the QLQ-C15-PAL compared with nonresponders.
  
  
  CONCLUSIONS
  Forty percent of patients experienced pain reduction and better QOL at day 10 after radiotherapy with further improvements in QOL at day 42 in responders. A single 8-Gy radiotherapy dose for bone metastases should be offered to all patients, even those with poor survival.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01248585.
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: McDonald
authors.affiliation: Canadian Clinical Trials Group, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Keyue
authors.initials: K
authors.lastname: Ding
authors.affiliation: Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Brundage
authors.affiliation: Juravinski Hospital and Cancer Centre, Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Ralph M
authors.initials: RM
authors.lastname: Meyer
authors.affiliation: Department of Radiation Oncology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Abdenour
authors.initials: A
authors.lastname: Nabid
authors.affiliation: Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, Québec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Chabot
authors.affiliation: Department of Radiation Oncology, CHUM-Hopital Notre-Dame, Montreal, Québec, Canada.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Coulombe
authors.affiliation: CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Shahida
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Grand River Regional Cancer Centre, Grand River Hospital, Kitchener, Ontario, Canada.
authors.forename: Joda
authors.initials: J
authors.lastname: Kuk
authors.affiliation: London Regional Cancer Program, London, Ontario, Canada.
authors.forename: A Rashid
authors.initials: AR
authors.lastname: Dar
authors.affiliation: Cancer Centre of Southeastern Ontario, Kingston General Hospital, Kingston, Ontario, Canada.
authors.forename: Aamer
authors.initials: A
authors.lastname: Mahmud
authors.affiliation: Cross Cancer Institute, Edmonton, Alberta, Canada.
authors.forename: Alysa
authors.initials: A
authors.lastname: Fairchild
authors.affiliation: Canadian Clinical Trials Group, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Carolyn F
authors.initials: CF
authors.lastname: Wilson
authors.affiliation: Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jackson S Y
authors.initials: JSY
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Dennis
authors.affiliation: Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Carlo
authors.initials: C
authors.lastname: DeAngelis
authors.affiliation: Princess Margaret Cancer Centre, Radiation Medicine Program, Ontario Cancer Institute, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rebecca K S
authors.initials: RKS
authors.lastname: Wong
authors.affiliation: Canadian Clinical Trials Group, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Liting
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chan
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology*; D002170:Canada; D000072716:Cancer Pain / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy*; D017326:Clinical Trials, Phase III as Topic; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010166:Palliative Care; D011471:Prostatic Neoplasms / Q000473:pathology*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
chemical_list: D000700:Analgesics; D000893:Anti-Inflammatory Agents; D003907:Dexamethasone