Work

RESPONSE: Re: Randomized Trial of Short- Versus Long-Course Radiotherapy for Palliation of Painful Bone Metastases

Year: 2006

Type: article

Abstract: We appreciate the information from Foro et al. concerning their study showing the efficacy of short-course radiotherapy in the palliation of painful bone metastases. This is additional corroboration in the growing body of literature confirming the equivalence of one or a few treatments compared with 10 or more treatments for palliation of pain. The higher incidence of retreatment after a short course of therapy is indeed a concern and should be the subject of further investigation to determine whether there is a specific subgroup that may benefit from longer-course, higher-dose radiotherapy. As suggested by Adli et al., there may be multiple factors related to the need for retreatment. We have begun to analyze our data to elucidate some of these factors, and we recently presented an analysis of the Radiation Therapy Oncology Group's (RTOG) 97-14 Trial that evaluated the incidence of retreatment with regard to sex, marital status, and performance status ( 1 ) . We found that both men and women who received 30 Gy in 10 fractions had a statistically significantly longer time to retreatment than those who received 8 Gy. Single men had no difference in retreatment rates between 8 and 30 Gy, whereas married men with a Karnofsky Performance Status of 70–80 Gy had a longer time to retreatment for the 30-Gy schedule than for the 8-Gy schedule. Both married and single women had a longer time to retreatment for the 30-Gy schedule than for the 8-Gy schedule. We are continuing to evaluate other factors that may help to differentiate those patients for whom the higher-dose, longer-course treatment is necessary. These data must be interpreted with caution, however. In most of the randomized bone metastasis studies (including RTOG 97-14), criteria for retreatment are typically not well defined and thus retreatment rates are not objective endpoints. Shakespeare et al. ( 2 ) have concluded that potential biases, including physician preference and patient selection, make retreatment rates an unreliable indicator of treatment efficacy.

Source: JNCI Journal of the National Cancer Institute

DOI: 10.1093/jnci/djj078

Authors: William F. Hartsell, Michelle DeSilvio, Deborah Watkins Bruner, Andre Konski

Institutions: Fox Chase Cancer Center, RTOG Foundation, Advocate Good Samaritan Hospital, University of Pennsylvania

Language: English

Topic: Management of metastatic bone disease

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

OpenAlex ID: W2141825369