34. A multicenter randomized study of two regimens in paliative radiotherapy of bone metastases

In this study we compared two methods of radiotherapy in patients with painful bone metastases: 20 Gy in five fraction in five consecutive days vs 8 Gy in one fraction. A total of 115 patients (34 males, 81 females), median age 56 years (23–80), were randomly allocated to one of the treatment arms. In 56 pts. Primary tumor was located in the breast, in 14 pts in the lung, in ten pts in the kidney, in seven pts in the prostate, and in 28 pts in other sites. A total of 146 metastatic bone lesions were irradiated, seventy five (51%) were treated with 20 Gy and seventy one (49%) – with 8 Gy. The most frequent location of metastatic lesions was spine (36%), followed by pelvis (25%), long bones (18%), ribs (12%) and other sites (12%). Treatment techniques included single field (73%) or two parallel opposed fields (27%). Complete pain relief was achieved in 36% of the lesions irradiated with 20 Gy and in 41% of those irradiated with 8 Gy. Partial improvement was observed in 46% and 43% of lesions, respectively. The median time to reappearance of pain in both groups was 5.4 a 4.8 months and 5.0 a 5.4 months respectively. We conclude that a single exposure to 8 Gy is of the same efficacy as 20 Gy in five fractions in pain control of bone metastases and should be recommended as routine management.