Study of three different fractionation regimens in palliative radiotherapy for painful bone metastases

Background: To assess the efficacy of single fraction with two different multi-fractionated radiotherapy regimens in treatment of painful bone metastases. Methods: Patients with painful bone metastases were randomly assigned to receive: Arm A: 8 Gray (Gy) in single fraction (n=15), Arm B: 20 Gy in 5 fractions at the rate of 4 Gy per fraction (n=15) and Arm C: 30 Gy in 10 fractions at the rate of 3 Gy per fraction (n=15). The arms were compared in terms of pain relief, performance improvement, analgesic requirement and duration of overall response at 1week, 1month, and 3 months after treatment. Results: Pain relief in Arms A, B and C at 1 week were 60%, 53.3% and 60%; at 1 month were 71.4%, 73.3%, 73.3%, at 3 months were 78.5%, 80% and 80% respectively. Performance improvement in Arm A, B and C at 1 week 60%, at 1 month 65%, 66% and 66%, at 3 months 78.5% ,80% and 80% respectively. Duration of overall response in all the patients who improved after therapy is 3 months There was no statistically significant difference between three arms with respect to pain relief, performance improvement, analgesic requirement and duration of overall response. Conclusions: The 8 Gy Single fraction is as efficacious as multi-fractionated regimens. Moreover, it is less expensive, decreases duration of hospital stay so single fraction can be used as an effective palliation method.