Radiotherapy for neuropathic pain due to bone metastases

Numerous randomized controlled trials have confirmed the effectiveness of radiotherapy (RT) to palliate painful bone metastases. Perhaps surprisingly, a single moderately large dose, typically 8 Gy, achieves similar intention-to-treat overall response rates (RRs) to higher dose fractionated schedules (e.g., 20-30 Gy in 5-10 fractions), namely around 60%. For assessable patients (i.e., excluding drop-out), the RRs are correspondingly higher, but still statistically equivalent for single vs. multiple fractions (72-74%). There are also no statistically significant differences in the rates of complete and partial pain response, pathological fracture or spinal cord compression at the treated site, or any notable differences in acute toxicity. Although re-irradiation rates are usually higher after single fractions (20% vs. 8%), this may partly be explained by the reluctance of radiation oncologists to re-treat after higher (fractionated) doses (1)