Back to Orthopedics Articles
A single dose of 8 gray of radiation appears to be as effective in
palliating painful bone metastases as the standard treatment schedule.
A single treatment of 8 gray (Gy--a unit of measure of
absorbed radiation dose) of radiation appears to be as
effective in palliating painful bone metastases as the
current U.S. standard treatment course of 30 Gy delivered in
10 daily treatments, according to a new study in the June 1
issue of the Journal of the National Cancer Institute.
Patients with a variety of solid tumor cancers, including lung,
breast, and prostate, can develop painful metastases in the bones of
the spine, pelvis, and extremities. Although the standard treatment,
radiation therapy delivered in 10 daily sessions, is effective in
providing relief--50% to 80% of patients experience improvement in
their pain, and 20% to 50% have complete pain relief--a shorter
course of treatment would be easier for patients and their families
to arrange and would also have less impact on the timing of other
To determine whether a shorter course of radiation is equivalent
to the standard treatment, William F. Hartsell, M.D., of Lutheran
General Cancer Center in Park Ridge, Ill., and colleagues randomly
assigned nearly 900 patients with breast or prostate cancer who had
one to three sites of painful bone metastases to receive either 8 Gy
of radiation in one treatment session or 30 Gy of radiation in 10
daily treatment sessions.
As assessed at three months after treatment, both regimens
provided equivalent pain relief, and an equivalent proportion of
patients no longer required narcotic medication. There was a higher
rate of re-treatment but less acute toxicity in the group that
received only one course of 8 Gy radiation compared with the 30-Gy
"Further analysis of data from [this] trial should yield
important information on quality of life, health utilities (i.e.,
patient preferences for specific health states or treatments), and
economic end points. These data will help determine whether a single
dose of 8 Gy should become the standard treatment for palliation of
localized painful bone metastases," they write.
In an editorial, Lisa Kachnic, M.D., of Boston University Medical
Center, and Lawrence Berk, M.D., Ph.D., of Central Ohio Radiation
Oncology in Columbus, discuss other trials that have addressed the
use of short-course radiation for the palliation of bone metastases.
"[T]hree very large randomized trials ? have all demonstrated that
single-fraction radiation therapy is sufficient to achieve
palliation of painful bone metastases," they write. "It remains to
be seen if this approach will become standard of care in the United
States. The outcome may distinguish whether radiation oncologists in
the United States practice evidence-based or remuneration-based
Article: Jackie Bailis, Lutheran General Cancer Center, 630
Editorial: Michelle Roberts, Boston University Medical Center,
Article: Hartsell WF, Scott CB, Bruner DW, Scarantino CW, Ivker
RA, Roach M III, et al. Randomized Trial of Short- Versus
Long-Course Radiotherapy for Palliation of Painful Bone Metastases.
J Natl Cancer Inst 2005;97:798?804.
Editorial: Kachnic L, Berk L. Palliative Single-Fraction
Radiation Therapy: How Much More Evidence Is Needed? J Natl Cancer