Management of metastatic bone pain: preliminary results with single fraction (4 Gy) radiotherapy.

Requests for reprints to: Prof. Dr. J. H. Karstens, Klinik für Strahlentherapie, Klinikum Aachen, Pauwelsstr., D-5100 Aachen (FRG) Results 17 sites (16 patients) were evaluable, whereas four sites (three patients) were not regarded evaluable because of a change of systemic therapy (two cases) ‚ a fracture of a long bone detected two days after irradiation (one case) or insufficient follow-up data (one case). 11 sites (11 patients) received a single treatment with 4 Gy without any further radiotherapy. Pain relief (= reduction of at least one point) was seen in five of 11 patients (45 %) resulting in a change of pain medication in four patients. In table 1 relevant data are listed. Pain relief occured in both weight bearing and non-weight bearing bones. No retreatment was considered necessary during follow-up (median follow-up: three months; range two weeks to seven months). A second group of six sites (six patients; five new patients plus patient 10, table 1) was formed. As they did not respond to single irradiation, a second dose was administered two weeks later. Four of these six patients responded after this second irradiation. Discussion A variety of fractionation schedules can be recommended for patients with symptomatic bone metastases. Two extreme ways are possible: 1) single fraction irradiation (e.g. only one planned fraction) and 2) fractionated radiotherapy (e.g. 15–20 fractions). Standard fractionated radiotherapy is clearly superior in the treatment of patients with spinal cord compression, Introduction Pain is a major symptom in 70% of all cancer patients [5]. Osseous metastases often are the cause of pain. Therefore, in many cases radiotherapy is important to achieve pain relief. Various dose/fractionation schedules are recommended for palliation of symptomatic osseous metastases. Single fraction radiotherapy may be useful, especially in patients with poor prognostic factors. Following a suggestion of a British colleague (P. Price; personal communication) we undertook a pilot study, using 4 Gy single fraction palliative radiotherapy. Patients and Methods Between January and October 1988, 21 patients with symptomatic osseous metastases were treated with a single 4 Gy fraction to reduce pain. Patients were excluded if a fracture of a long bone was causing the pain and vertebral metastases were the origin of patients distress. The latter were irradiated with standard fractionation radiotherapy. 21 sites in 20 patients with known malignant tumors were treated with a single portal (telecobalt or electron field) or two parallel opposing fields (telecobalt or 10 MV photons of a linear accelerator) with a prescribed dose of 4