A Comparative Study Between Two Multi-Fraction Radiation Schedules; 20 Gy in 5 Fractions versus 30Gy in 10 Fractions in Palliative Management of Painful Bone Metastases | ||||
| SECI Oncology Journal | ||||
| Article 6, Volume 12, Issue 4, October 2024, Page 367-377 | ||||
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| Abstract | ||||
| Background: Bone metastases (BM) are a painful complication of advanced malignancies, significantly reducing patients' quality of life. Radiotherapy (RT) is a cornerstone in the palliative treatment of BM, with different fractionation schedules used globally. This study compared two multi-fractionated RT regimens -30 Gy/10 and 20 Gy/5 fractions- focusing on pain control, re- irradiation rates, relapse, toxicity, and overall survival (OS). Methods: This prospective, randomized controlled trial was conducted at the South Egypt Cancer Institute, Assiut University, including 100 patients with confirmed painful BM. Patients received either 30 Gy/10 fractions (n=50) or 20 Gy/5 fractions (n=50). Pain relief was assessed using the Visual Analogue Scale at 1- and 3-months post-treatment. Re-irradiation rates, relapse, acute toxicity, pathological fractures, spinal cord compression, and 1-year OS were evaluated. Results: At 1 month, the overall response rate was 88% in the 30 Gy group and 82% in the 20 Gy group (p=0.9), with similar results at 3 months (76% vs. 72%, p=0.991). Although both regimens provided effective pain control, patients in the 30 Gy group had a lower rate of pain progression (1.6% vs. 6.5%) and re- irradiation (6% vs. 12%) compared to the 20 Gy group. Acute toxicity was significantly higher in the 30 Gy group, with 25% experiencing Grade 1-2 toxicity compared to 5% in the 20 Gy group (p<0.0001). Skin reactions and fatigue were the most common side effects. Pathological fractures and spinal cord compression were observed in 4% and 6% of patients in the 20 Gy group, compared to 2% in both categories in the 30 Gy group. 1-year OS was comparable between groups (35% for 20 Gy and 39% for 30 Gy, p=0.527). Conclusion: Both regimens offered high rates of pain relief, but the 30 Gy regimen provided more durable pain control, reflected in lower re-irradiation rates and pain progression. However, this came at the cost of higher acute toxicity. The 20 Gy might be more appropriate for patients with a lower performance status or in high-volume centers where shorter treatment times and fewer side effects were prioritized. | ||||
| Keywords | ||||
| Palliative Care; Bone Metastases; Radiotherapy; Pain Management | ||||
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