Painful bone metastasis: efficacy of radiotherapy assessed by the patients; a randomized trial comparing 4 Gy x 6 versus 10 Gy x 2

Fifty-seven patients with painful bone metastases were randomized to receive 4 Gy in 6 fractions over 3 weeks with 2 fractions per week or 10 Gy in 2 fractions with an interval of one week. Pain intensity was assessed by scoring the consumption of analgesics combined with patient self-evaluation on a visual analogue scale. Treatment results were identical in the two treatment groups, with satisfactory pain control in about 48% of the patients. In other studies with physician evaluation of pain control, better results have invariably been reported, suggesting some degree of observer bias. A review of the literature as well as the results of this study indicates that within wide ranges no optimal radiation schedule or dose exist for reducing pain in bone metastases. Therefore short courses of treatment using moderate doses should be preferred for the convenience of the patients