News Release

For painful bone metastases, single-fraction radiotherapy as effective and saves money

Peer-Reviewed Publication

Journal of the National Cancer Institute

For the same medical benefit, the total medical and societal costs of single-fraction radiotherapy are lower than that of multiple-fraction radiotherapy for cancer patients with painful bone metastases, according to a randomized trial in the February 5 issue of the Journal of the National Cancer Institute.

Pain from bone metastases is typically treated with either single-fraction radiotherapy, where a large dose of radiation is given in one session, or multiple-fraction radiotherapy, where radiation is delivered in smaller doses over a period of several weeks. Although there is still some debate about which treatment schedule is better, studies have suggested that single-fraction and short-term radiotherapy are as effective at reducing pain as longer-term treatments. One large randomized trial, the Dutch Bone Metastasis Study, showed that single-fraction radiotherapy is comparable to multiple-fraction radiotherapy, with no statistically significant differences in pain response, side effects from treatment, or quality of life.

To find out which radiotherapy schedule offers more value for the money, Wilbert B. van den Hout, Ph.D., of the Leiden University Medical Center in the Netherlands, and his colleagues from the Dutch Bone Metastasis Study Group performed a cost–utility analysis on the Dutch Bone Metastasis Study. The original study involved 1,157 Dutch patients with painful bone metastases who were randomly assigned to receive either single-fraction radiotherapy or multiple-fraction radiotherapy.

In the cost–utility analysis, the authors found no difference in life expectancy between the two patients groups. The average life expectancies were 43 weeks for the single-fraction schedule and 40.4 weeks for the multiple-fraction schedule, which was not a statistically significant difference. There was also no difference in quality-adjusted life expectancy. Multiple-fraction radiotherapy was more expensive than single-fraction radiotherapy ($3,311 compared with $2,438, including retreatment costs and costs incurred by the patients).

The authors point out that all Dutch institutions have adopted single-fraction radiotherapy as their standard treatment. "Compared with multiple-fraction therapy, single-fraction therapy provides equal palliation to patients and reduces the number of journeys to the hospital," the authors write. They recommend that single-fraction radiotherapy be considered as the palliative treatment of choice for cancer patients with painful bone metastases.

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Contact: Else Mulder, Leiden University Medical Center, 31-71-526-8005; fax: 31-71-524-8134, voorlichting@LUMC.NL

van den Hout WB, van der Linden YM, Steenland E, Wiggenraad RGJ, Kievit J, de Haes H, et al. Single- versus multiple-fraction radiotherapy in patients with painful bone metastases: cost–utility analysis based on a randomized trial. J Natl Cancer Inst 2003;95:222–9.

Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage.


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