Study Finds Benefits of Single Dose Radiation for Treatment of Metastatic Bone Pain
When an individual has cancer, it’s possible for tumor cells to spread to their bones and cause severe pain. When this happens, radiation therapies are often used to help with pain relief and to attempt to decrease the size of bone tumors. The current standard of treatment is to deliver multiple, lower doses of radiation to the sites of bone metastases; however, some experts believe that the same treatment outcome can be achieved with one larger dose of radiation instead. A recently published study based out of the University of Texas MD Anderson Cancer Center suggests that not only is the single-dose option possible, but it may also be more beneficial.
What does the research say?
Similar trials in the past have looked at single versus multiple doses of radiation for bone metastases, and most concluded that there was no advantage of one dose over many. Some concluded that one dose actually may lead to a higher rate of pain recurrence when compared to multiple radiation doses. However, in the new study published in the journal JAMA Oncology, this was not the case. Past trials used treatment options available at the time, such as 2-dimensional radiation therapy and low radiation doses (8 Gy, or 8 gray—a measurement of radiation). In the newer study, the researchers were able to use higher doses of radiation (12 or 16 Gy), and newer technologies, like 3-dimensional radiation therapy, and intensity-modulated radiation therapy (IMRT). When using higher doses and newer methods, the researchers found that single, higher doses may provide benefit.
Testing this new theory
In order to test their theory, the researchers conducted a Phase 2 clinical trial where they treated a sample of 160 individuals with non-spinal, painful metastatic bone tumors at the University of Texas MD Anderson Cancer Center. Half of the participants were randomly assigned to receive single-fraction stereotactic body radiotherapy (SBRT) one time, and the other half received the standard multifraction radiotherapy (MFRT). The multi-dose group received 30 Gy total of radiation in 10 doses over two weeks.
The researchers monitored pain medication usage, and utilized pain questionnaires answered by participants to determine how much, if any, pain relief occurred as a result of treatment. The results indicated that the single-dose treatment regimen was no less effective than the multi-dose. In fact, those treated with a single, high dosage of radiation actually had a greater chance of having some or all of their bone pain alleviated when compared to the multi-dose group. This trend was found at the two week, three month, and nine month marks. Additionally, the tumor recurrence rate at treatment sites was lower for those given the single dose when compared to the multi-dose group at the one- and two-year post-treatment marks.
What about radiation side effects?
The higher, single dose of radiation was found to have no differences in side effects from the smaller, multiple doses, and was safe and effective. There were also no differences found in treatment-related fatigue or quality of life assessments between the two different groups. Further research with more participants is being planned to better understand the differences between single and multi-dose treatment for painful bone metastasis, however, these results are promising for those living with bone pain and looking for relief.
Positive steps moving forward
Severe bone pain may lead to dramatic detriments to quality of life for those with cancer. Although radiation therapy for bone metastases is not a curative treatment at this time, finding a way to alleviate this pain in the most efficient way possible may improve the day to day experiences of those with more advanced cancers. New knowledge like this is critical and may impact the way individuals with metastatic cancer are treated in the future.
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