[Radiotherapy for symptomatic osseous metastases: special reference to the analysis of patients achieved complete pain relief]

A total of 223 patients with 498 symptomatic osseous metastases treated by radiotherapy between July 1985 and June 1991 were retrospectively analyzed. Most sites, 409 (82%), were irradiated by conventional fractionation, while the remaining 89 sites were irradiated by dose-increment fractionation, low-dose short schedules or hyperfractionation. The total dose ranged from 5.4 to 74 Gy (mean, 41.4 Gy). Daily pain assessment was done by patients themselves on an 11-point scale, i.e., 10: pretreatment pain, 0: disappearance of pain following radiotherapy. In addition, improvement in performance status (PS) and the duration of complete pain relief were assessed. The following results were obtained. 1) Pain relief: Of 498 evaluated sites, complete pain relief and partial pain relief were achieved in 403 sites (81%) and 64 sites (13%), respectively. No significant difference was seen in the incidence of complete pain relief between weight-bearing bone and non-weight-bearing bone. Patients with PS 1, 2 or 3 were significantly superior to those with PS 4 in terms of complete pain relief (P < 0.05-0.001). The complete response rate increased in accordance with the dose delivered, i.e., 49% at 20 Gy, 70% at 30 Gy and 77% at 40 Gy, in all of the 498 sites irradiated; 60%, 86% and 95% of 403 sites, respectively, achieved complete pain relief. Regarding the fractionation regimens, dose-increment fractionation was superior to both conventional fractionation and low-dose short schedules in terms of complete pain relief rate. 2) Improvement of PS: Of 223 evaluated patients, PS was improved 1 to 3 steps in 162 (73%) at the completion of radiotherapy. The improvement rates of patients with PS 2 or 3 were significantly better than those with PS 4 (P < 0.025, 0.001). 3) Duration of complete pain relief: Of 288 appraisable sites, the recurrence of pain was recognized in 23 (9%) at intervals of 3 to 21 months (median, 5 months). On the other hand, the duration of pain relief was 16 to 79 months (median, 32 months) in 26 sites of survivors, and 1 to 28 months (median, 5 months) in 239 sites of decreased patients. The mean total dose was 48.5 Gy (TDF: 82) to 62 sites with a duration of pain relief of more than 13 months. 4) Re-irradiation to the same site: Of 14 sites retreated after initial complete response with a total dose of 30 to 50 Gy (mean, 48 Gy), 11 (79%) were in weight-bearing bone and 9 (64%) responded completely. 5) Patients with unsatisfactory pain relief (pain score > or = 6): Of 31 sites, 27 (94%) were in patients with PS 4, and 19 (61%) received a total dose below 30 Gy. 6) The 11-point scale for patient self-assessment of pain relief following radiotherapy was thought to be useful and easy to adopt in general clinics.