Single-dose radiotherapy best for painful spine metastases

By Lynda Williams, Senior medwireNews Reporter

Research supports the use of single-fraction radiotherapy (SFRT) for the treatment of painful vertebral bone metastases (PVBM).

Data for 235 patients with breast or prostate cancer PVBM indicate that SFRT was associated with significantly less acute grade 2-4 toxicity than conventional multifraction radiotherapy (MFRT), affecting 20% and 10% of patients, respectively, as well as acute grade 2-4 gastrointestinal toxicity, at 14% and 6%.

Furthermore, after 3 months, patients who received a single 8 Gy dose had comparable pain relief to those given 30 Gy in 10 fractions over 2 weeks (62 vs 70%), and similar freedom from narcotic use (24 vs 27%). Late toxicity was rare in both treatment groups and there were no reports of myelopathy.

Although patients given SFRT had a significantly greater need for retreatment within 3 years than MRFT patients (15 vs 5%), the researchers say this finding should be considered in the context of the total number of hospital visits for the two radiotherapy regimes.

Even when including retreatment, 100 patients given SFRT will make 230 visits compared with 1155 visits by 100 MFRT patients, estimate David Howell (University of Michigan, Ann Arbor, USA) and co-authors.

"On a humanitarian note, the use of SFRT in this clinical setting saves the patient and their caregivers from having to make an additional 9 visits to the radiation oncology facility. It saves direct and indirect costs of additional time off work, transportation, lodging, childcare, and other costs," the researchers write in Cancer.

"The use of SFRT also saves time for health care providers and radiation therapists, and it reduces linear accelerator use," they add.

Howell et al note that patients in this study had PVBM affecting the cervical, thoracic, and/or lumbar spine but the significant increased rate for retreatment associated with SFRT was attributed to patients with lumbar metastases, rather than those with tumors affecting other or multiple sites.

Indeed, 68% of the 25 patients who received retreatment had treatment to the lumbar spine.

Explaining that the decision to retreat was made at the discretion of the treating physician, they suggest: "The higher lumbar spine retreatment rate may have been influenced by the absence of the spinal cord below lumbar segment 1…, which may have had an impact on decisions to retreat."

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