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Original Investigation
July 2017

Effect of Radiotherapy on Painful Bone Metastases: A Secondary Analysis of the NCIC Clinical Trials Group Symptom Control Trial SC.23

Author Affiliations
  • 1Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • 2Canadian Clinical Trials Group, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
  • 3Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
  • 4Juravinski Hospital and Cancer Centre, Department of Oncology, McMaster University, Hamilton, Ontario, Canada
  • 5Department of Radiation Oncology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
  • 6Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, Québec, Canada
  • 7Department of Radiation Oncology, CHUM-Hopital Notre-Dame, Montreal, Québec, Canada
  • 8CancerCare Manitoba, Winnipeg, Manitoba, Canada
  • 9Grand River Regional Cancer Centre, Grand River Hospital, Kitchener, Ontario, Canada
  • 10London Regional Cancer Program, London, Ontario, Canada
  • 11Cancer Centre of Southeastern Ontario, Kingston General Hospital, Kingston, Ontario, Canada
  • 12Cross Cancer Institute, Edmonton, Alberta, Canada
  • 13Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
  • 14Department of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
  • 15Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • 16Princess Margaret Cancer Centre, Radiation Medicine Program, Ontario Cancer Institute, University of Toronto, Toronto, Ontario, Canada
JAMA Oncol. 2017;3(7):953-959. doi:10.1001/jamaoncol.2016.6770
Key Points

Question  How soon after radiotherapy for painful bone metastases can an improvement in quality of life be expected?

Findings  In this secondary analysis of 238 patients from the NCIC Clinical Trials Group Symptom Control Trial SC.23, responders to radiotherapy had significantly greater improvement in pain, pain characteristics, functional interference, and psychosocial aspects at day 10 and significant improvement in most domains of the European Organisation for Research and Treatment of Cancer Quality of Life Bone Metastases Module and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative at day 42 compared with nonresponders.

Meaning  Quality of life and pain may improve as early as 10 days after radiotherapy; thus, a single 8-Gy dose of radiotherapy for painful bone metastases should be offered to all patients, even those with poor survival.

Abstract

Importance  Many studies that found improved quality of life (QOL) after radiotherapy of bone metastases have small sample sizes and do not use specific questionnaires. How soon after radiotherapy one can expect an improvement in QOL is unknown.

Objective  To investigate QOL at days 10 and 42 after radiotherapy with a bone metastases–specific QOL tool.

Design, Setting, and Participants  In this secondary analysis of the NCIC Clinical Trials Group Symptom Control Trial SC.23, a double-blind randomized clinical trial that investigated dexamethasone for the prophylaxis of pain flare after radiotherapy, patients were accrued from 23 Canadian centers from May 30, 2011, to December 11, 2014, and were followed up for 42 days after treatment. Participants referred for radiotherapy for bone metastases were required to have a pain score at the site(s) of treatment of at least 2 (range, 0-10).

Interventions  Patients were treated with a single 8-Gy radiotherapy dose for 1 or 2 bone metastases.

Main Outcomes and Measures  Patients reported their worst pain score and analgesic intake at baseline and days 10 and 42 after treatment. Pain response was assessed with International Bone Metastases Consensus Endpoint Definitions. Self-reported QOL was completed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Bone Metastases Module (QLQ-BM22) and the European Organisation for Research and Treatment of Cancer Quality of Life Core 15 Palliative (QLQ-C15-PAL) at the same time points.

Results  A total of 298 patients were accrued (median age, 68.8 [range, 32-94] years at day 10 and 68.0 [range, 34-90] years at day 42). A total of 122 patients (40.9%) responded to radiotherapy at day 10 and 116 patients (38.9%) at day 42. At day 10, compared with nonresponders, patients with a pain response had a greater reduction in pain (mean reduction, 17.0 vs 1.8; P = .002) and pain characteristics (mean reduction, 12.8 vs 1.1; P = .002), as well as greater improvements in functional interference (mean increase, 11.6 vs 3.6; P = .01) and psychosocial aspects (mean increase, 1.2 points in responders vs mean decrease of 2.2 points in nonresponders, P = .04). Comparing changes in QOL from baseline to day 42, responders had significantly greater improvements in the physical (mean increase, 6.2 vs −9.0; P < .001), emotional (mean increase, 12.3 vs −5.5; P < .001), and global domains (mean increase, 10.3 vs −4.5; P < .001) of the QLQ-C15-PAL compared with nonresponders.

Conclusions and Relevance  Forty percent of patients experienced pain reduction and better QOL at day 10 after radiotherapy with further improvements in QOL at day 42 in responders. A single 8-Gy radiotherapy dose for bone metastases should be offered to all patients, even those with poor survival.

Trial Registration  clinicaltrials.gov Identifier: NCT01248585

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