Radiotherapy benefits bone metastases ‘even in last months of life’
MedWire News: Palliative radiotherapy benefits patients with painful bone metastases even in the last few months of life, and should be routinely considered as a treatment option, researchers say.
It is well established that external beam radiotherapy can relive the pain of bone metastases, with typical response rates of around 60%, albeit with a lag time of up to 1 month before treatment effects are felt.
Palliative radiotherapy is also known to benefit patients who are very close to the end of their life; however, treatment in this setting is not well researched.
Edward Chow (Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada) and associates reviewed data from 109 patients with bone metastases, primarily from lung, prostate, or gastrointestinal cancers, who were treated with palliative radiotherapy and died within 3 months of treatment initiation.
The average age of the patients was 69 years and the majority (58%) received single fraction treatment.
After 1 month, 3% of patients had a complete response to treatment, defined as a pain score of 0 at the treated site with no need for increased use of analgesia.
At the same time point, 67% of patients had a partial response rate, defined as either a 2-point reduction in pain score at the treated site and no concomitant increase in analgesic intake, or a 25% reduction in analgesic intake and no increase in pain score at the treated site.
After 2 months of treatment, no patients experienced a complete pain response but 63% maintained a partial response.
"The present study is only the second report to date on the efficacy of radiotherapy for the palliation of bone metastases among patients in their last 3 months of life, and it is the first to present data from a cohort with such short lived survival in the setting of daily clinical practice, rather than the select, highly controlled environment of a clinical trial," Chow and colleagues conclude in the journal Clinical Oncology.
Based on their results, the researchers recommend that "patients suffering from painful bone metastases with an estimated survival of 3 months should still be considered for palliative radiotherapy."
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By Philip Ford