A single 8-Gy dose of radiotherapy for painful bone metastases may improve quality of life and pain as early as 10 days after administration, a study published in JAMA Oncology has shown.1

Although various studies have demonstrated improved quality of life after radiotherapy of bone metastases, they are limited by their small sample sizes and lack of specific questionnaires. In addition, it is unclear how soon after radiation treatment patients can expect to perceive an improvement in quality of life.

To investigate quality of life at days 10 and 42 after radiotherapy, researchers surveyed 298 patients participating in the NCIC Clinical Trials Group Symptom Control Trial SC.23, a double-blind randomized clinical trial that investigated dexamethasone for the prophylaxis of pain flare after radiotherapy, who were referred for radiotherapy for bone metastases. Investigators only included patients if they had a pain score at the site(s) of treatment of at least 2.

Results showed 40.9% of patients responded to radiotherapy at day 10 and 38.9% at day 42. At day 10, patients who achieved a pain response had a significantly greater reduction in pain (P = .002) and pain characteristics (P = .002) compared with nonresponders. Responders also achieved significantly greater improvements in functional interference (P = .01) and psychosocial aspects (P = .04) vs nonresponders.

At day 42, responders demonstrated significantly greater improvements in the physical (P < .001), emotional (P < .001), and global domains (P < .001) compared with nonresponders.

Researchers measured pain response with International Bone Metastases Consensus Endpoint Definitions. Self-reported quality of life was evaluated using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Bone Metastases Module (QLQ-BM22) and the European Organisation for Research and Treatment of Cancer Quality of Life Core 15 Palliative (QLQ-C15-PAL) at days 10 and 42 after radiotherapy.

Given the findings that show patients with painful bone metastases may see improvements in quality of life and pain as early as 10 days after radiotherapy, clinicians should consider a single 8-Gy dose of radiotherapy for all patients with painful bone metastases, including those with poor survival.

Reference

1. McDonald R, Ding K, Brundage M, et al. Effect of radiotherapy on painful bone metastases. JAMA Oncol. 2017 Feb 9. doi: 10.1001/jamaoncol.2016.6770 [Epub ahead of print]