A Comparative Study Between Two Multi-Fraction Radiation Schedules; 20 Gy in 5 Fractions versus 30Gy in 10 Fractions in Palliative Management of Painful Bone Metastases
Abstract
Background: Bone metastases (BM) are a painful complication of advanced malignancies, significantly reducing patients' quality of life. Radiotherapy (RT) is a cornerstone in the palliative treatment of BM, with different fractionation schedules used globally. This study compared two multi-fractionated RT regimens -30 Gy/10 and 20 Gy/5 fractions- focusing on pain control, re- irradiation rates, relapse, toxicity, and overall survival (OS). Methods: This prospective, randomized controlled trial was conducted at the South Egypt Cancer Institute, Assiut University, including 100 patients with confirmed painful BM. Patients received either 30 Gy/10 fractions (n=50) or 20 Gy/5 fractions (n=50). Pain relief was assessed using the Visual Analogue Scale at 1- and 3-months post-treatment. Re-irradiation rates, relapse, acute toxicity, pathological fractures, spinal cord compression, and 1-year OS were evaluated. Results: At 1 month, the overall response rate was 88% in the 30 Gy group and 82% in the 20 Gy group (p=0.9), with similar results at 3 months (76% vs. 72%, p=0.991). Although both regimens provided effective pain control, patients in the 30 Gy group had a lower rate of pain progression (1.6% vs. 6.5%) and re- irradiation (6% vs. 12%) compared to the 20 Gy group. Acute toxicity was significantly higher in the 30 Gy group, with 25% experiencing Grade 1-2 toxicity compared to 5% in the 20 Gy group (p<0.0001). Skin reactions and fatigue were the most common side effects. Pathological fractures and spinal cord compression were observed in 4% and 6% of patients in the 20 Gy group, compared to 2% in both categories in the 30 Gy group. 1-year OS was comparable between groups (35% for 20 Gy and 39% for 30 Gy, p=0.527). Conclusion: Both regimens offered high rates of pain relief, but the 30 Gy regimen provided more durable pain control, reflected in lower re-irradiation rates and pain progression. However, this came at the cost of higher acute toxicity. The 20 Gy might be more appropriate for patients with a lower performance status or in high-volume centers where shorter treatment times and fewer side effects were prioritized.
(2024). A Comparative Study Between Two Multi-Fraction Radiation Schedules; 20 Gy in 5 Fractions versus 30Gy in 10 Fractions in Palliative Management of Painful Bone Metastases. SECI Oncology Journal, 12(4), 367-377.
MLA
. "A Comparative Study Between Two Multi-Fraction Radiation Schedules; 20 Gy in 5 Fractions versus 30Gy in 10 Fractions in Palliative Management of Painful Bone Metastases", SECI Oncology Journal, 12, 4, 2024, 367-377.
HARVARD
(2024). 'A Comparative Study Between Two Multi-Fraction Radiation Schedules; 20 Gy in 5 Fractions versus 30Gy in 10 Fractions in Palliative Management of Painful Bone Metastases', SECI Oncology Journal, 12(4), pp. 367-377.
VANCOUVER
A Comparative Study Between Two Multi-Fraction Radiation Schedules; 20 Gy in 5 Fractions versus 30Gy in 10 Fractions in Palliative Management of Painful Bone Metastases. SECI Oncology Journal, 2024; 12(4): 367-377.