Palliative radiotherapy worthwhile for end-stage painful bone metastases
MedWire News: Contrary to concerns, patients suffering bone metastases with only 3 months to live should still receive palliative radiotherapy, say researchers.
Edward Chow and colleagues, from the University of Toronto in Ontario, Canada, investigated the efficacy of radiotherapy for the palliation of pain from bone metastases, a topic they say "has been subjected to little scientific rigor."
Their aim was to resolve a matter of dispute: "Reservations regarding the appropriateness of palliative radiotherapy for patients with limited lifespans stem at least in part from concerns over fractionated treatment courses that extend for many weeks and are often prematurely terminated due to patient decline."
The research comprised a retrospective analysis of two mutually exclusive databases of patient responses to two questionnaires: the Edmonton Symptom Assessment System (ESAS), which is designed to measure levels of pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath among patients receiving palliative care; and the Brief Pain Inventory (BPI), which measures pain severity among cancer patients. Both use numerical rating scales to describe severity of suffering.
The team identified 148 men and 84 women, aged a median of 69 months, who died within 3 months of beginning external beam radiotherapy for bone metastases.
The three most common cancers in this cohort were lung (34%), prostate (18%), and gastrointestinal (14%).
Pain response data were available for 47% of patients. These responses to radiotherapy were defined according to the endpoints of the International Bone Metastases Consensus. Overall, 70% of patients reported an improvement in their pain at the 1-month follow-up and 63% at the 2-month follow-up.
A complete response was defined as a pain score of 0 at follow-up with no increased use of analgesics. Three patients reported complete response at the1-month follow-up, but this decreased to no patients after 2 months.
The rest of the responders were categorized "partial responders," which Chow's team defined as either: a 2-point reduction in pain score without an increase in analgesic use, or a 25% reduction in analgesic intake and no increase in pain score.
"This suggests that even patients with very limited life expectancies could derive some benefit from palliative radiotherapy," write the researchers.
As 58% of the patients in this study received single fraction treatment, the team suggests that this form of treatment could help reduce the concerns that currently exist over using radiotherapy for bone metastases in patients with 3 months to live.
They also point out that survival estimates for patients receiving palliative radiotherapy have "historically been overoptimistic." They therefore emphasize that it is "important to ensure that patients receiving radiotherapy are being followed by their family physicians or palliative care specialists who can co-ordinate comprehensive end of life care."
However, they conclude that palliative radiotherapy should still be considered for treating painful bone metastasis in patients with a 3-month life expectancy.
Their findings are published in the journal Clinical Oncology.
By Chloe McIvor