Evaluation of 6GY Single Dose Radiotherapy in comparison with 8GY Single Dose Radiotherapy in the treatment of painful bone metastases

Sathiyamoorthy, P N (2010) Evaluation of 6GY Single Dose Radiotherapy in comparison with 8GY Single Dose Radiotherapy in the treatment of painful bone metastases. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Bone metastases often present as the first evidence of disseminated disease. The incidence of bone metastases varies significantly depending on the primary site, with breast and prostate cancer accounting for up to 70% of patients with metastatic disease. Even though the ultimate prognosis is poor, a proportion of the patients may survive for several months or even years and will require active treatment because of symptoms related to their bone metastases. Pain, pathologic fractures, hypercalcemia, neurologic deficits, and immobility decrease the quality of remaining life for these patients. Associated depression and anxiety may further compromise the quality of survival. Radiation therapy is considered as the treatment of choice for palliation of painful bone metastases for many years Its main aim is relief of bone pain, prevention of pathological bone fractures as well as its healing, with anticipated effect upon improving mobility, function, and quality of life. Also, data from retrospective studies and prospective randomized trials showed that single fraction treatments may be as effective as multifraction regimens. Since single fraction treatment may be advantageous for both patient and institution, various single dose fraction schedules have been investigated. Yet, optimal single dose of RT required for pain relief is unknown, although one study showed that 8 Gy gives a higher probability of pain relief than 4 Gy. Furthermore, a dose level in - between the 4 Gy and 8 Gy (namely, 6 Gy) also appeared to be effective in achieving pain relief, not very different from that achieved with 8 Gy. In order to define the “lowest” optimal single dose of RT in the treatment of patients with metastatic bone pain, we underwent a prospective randomized trial comparing two single-fraction regimens of RT exploring dose-response effect in this trial setting. AIM OF THE STUDY: The present study aims at comparing pain relief obtained with (trial arm) 6Gy single fraction radiotherapy against 8Gy single fraction radiotherapy (control arm) in painful bone metastases. The study also aims at comparing the Toxicity , Infield Events involved with the above two therapeutic protocols. MATERIALS AND METHODS: STUDY PERIOD : From July 2008 up to June 2009. ELIGIBITY CRITERIA: sixty patients with painful bone metastases who satisfied the following eligibility criteria were included in this study. 1. Age > 18 years, 2. Genders: Both Male and Females, 3. Performance status: ECOG 0 – 3, 4. Histological or cytological diagnosis of malignancy associated with radiological evidence of painful bone metastases from any primary tumor site. 5. If patients with two sites of pain requiring separate treatment are to be entered, the same randomized treatment option will be used for both sites, but response at each site will be scored and analyzed separately. 6. Anticipated remaining life of at least 12 weeks (3 months). 7. Pain due to bone metastases. 8. Evaluable pain history. 9. Informed consent. EXCLUSION CRITERIA : 1. Primary histology myeloma. 2. Sites of previous RT or previous radioisotope treatment. 3. Bisphosphonate treatment. 4. Previous surgical intervention at the same locus. 5. Complicated bone metastases (pathological fractures, metastatic spinal cord compression) conditions or circumstances, which may interfere with treatment or follow-up. RESULTS: Out of the 1802 Cancer patients treated between July- 2008 and June- 2009 in our Radio therapy dept, 85 (4.7%) presented with bone metastases. A total of 60 patients with single and multiple bone metastases who met the eligibility criteria entered into this study at the time they developed their first painful bone metastases. Any subsequent metastases and its treatment was not included in the study and every effort was made to distinguish the pain that first occurred from that of any subsequent metastatic site, even in the cases of pain recurrence at the original site in the presence of painful second or any other additional metastatic bone site. CONCLUSION: The following conclusions can been drawn from this prospective trial which compared 6Gy single fraction radiotherapy with already proven 8Gy single fraction radiotherapy in the treatment of painful bone metastases. The 6Gy single fraction radiotherapy produces similar , time to the first occurrence of any pain relief, duration of response in responders, complete response rate, overall response rate, retreatment rate and toxicity with 8Gy single fraction radiotherapy in the treatment of painful bone metastases. We conclude that single fraction 6Gy radiotherapy is good option in palliation of painful bone metastases.

Item Type: Thesis (Masters)
Uncontrolled Keywords: 6GY Single Dose Radiotherapy ; 8GY Single Dose Radiotherapy ; treatment ; painful bone metastases.
Subjects: MEDICAL > Radio Therapy
Depositing User: Punitha K
Date Deposited: 23 May 2018 17:14
Last Modified: 23 May 2018 17:14
URI: http://repository-tnmgrmu.ac.in/id/eprint/8091

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