Single Fraction Radiation for Bone Metastases

A study based on patient-reported outcomes in a broad sample of cancer patients with bone metastases showed that single fraction radiation therapy (SFRT) was as effective as multiple fraction radiation therapy (MFRT) for alleviating pain and improving function and quality of life (QOL).

This study has cost implications as well as implications for patient convenience, noted senior author Robert Olson, MD, a radiation oncologist at the British Columbia (BC) Cancer Agency Centre for the North, Canada. “We see variations in patterns of use of MFRT. No doubt some of the use of MFRT [in the United States] is driven by cost considerations,” he noted.

“Previous studies have shown that SFRT is equally effective as the more costly and inconvenient MFRT for patients with painful bone metastases. Many patients typically seen in clinical practice—those with fractures, neurologic damage—are excluded from these trials, though. There is a low utilization of SFRT worldwide, partly because oncologists are often reluctant to treat patients who do not mirror those in clinical trials,” he said.

The study is ongoing. Results presented at ASTRO were based on self-reports from 648 patients treated with RT for bone metastasis. Patients were asked about pain levels, physical function, and symptom frustration.

No major differences were seen between SFRT and MFRT for these parameters. Partial pain response was achieved in 73% of those treated with SFRT or MFRT; complete pain response was achieved in 19% and 22%, respectively. Improvement by 1 point or more was similar in both groups: improvement in functional complaints by at least 1 point was observed in 71% and 77%, respectively; and at least a 1-point improvement in symptom frustration was reported by 77% and 80%, respectively.

“These findings indicate that SFRT should be the standard management policy for uncomplicated bone metastases. Although the study is limited by a small sample size thus far, there is no evidence of inferiority for SF versus MF in complicated bone metastases,” Olson stated.

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Reference

1. Olson RA, Olivotto L, Tiwana M, et al. Impact of program-wide dissemination of the inconsistent utilization of single fraction radiation therapy for bone metastases across a provincial program. Int J Radiat Oncol Biol Phys. 2014;90(1)(suppl):S691. Presented at: 56th Annual Meeting of the American Society for Radiation Oncology; September 14-17, 2014; San Francisco, CA. Abstract 3222.