Palliative radiation is often used to treat the pain that accompanies metastatic bone tumors. How much and how often to use this treatment has been debated and studied, and using multiple lower doses is generally the current standard. A new clinical trial employing contemporary radiation technologies including three-dimensional radiation therapy and intensity-modulated radiation therapy (IMRT) found that a single high dose of radiation was just as effective for pain reduction as multiple smaller doses, and actually provided more patients with long-term pain relief.
“This is one of the most exciting studies about the value of radiotherapy treatments for bone pain to come out in the past several years,” radiation oncologist Stephen Lutz, M.D., of Eastern Woods Radiation Oncology in Ohio, who was not involved in the research, said.
A total of 160 patients who had painful bone metastases (the majority did not involve the spine) at the University of Texas MD Anderson Cancer Center participated in the trial, which compared one higher dose of radiation to multiple lower doses over a two-week period. The researchers analyzed pain questionnaires and found the single delivery of radiation therapy was not inferior to the multiple doses in regard to pain control or recurrence at the site. In fact, a greater number of the patients who received a single-dose reported all or some of the pain had been alleviated at various time intervals up to nine months, compared with those patients in the multiple-dose group. What’s more, after one and two years went by, the tumor recurrence rate at the treated cancer sites was lower in the group that received a single treatment.
Previous studies suggested that a single treatment might work, but that its effectiveness might wear off more quickly. Lutz attributes the new findings to advances in radiation; “The results of this study suggest that the effectiveness of radiation therapy can be greatly improved by using new technologies.” He added, “The current results are based on a small number of patients and will need to be confirmed in a larger group treated at multiple different cancer centers.”
Lead author Quynh-Nhu Nguyen, M.D. said, “We should individualize our care for [patients],” based on their conditions and overall health. For a person with a life expectancy of less than a month, “it’s reasonable to give them a single low dose of radiation for pain,” she explained.
For people with a longer life expectancy, “it makes sense to give them a single higher dose of radiation to alleviate pain over the long term.
Sources: National Cancer Institute, JAMA Oncology