The management of painful bone metastases with biphosphonates and palliative radiotherapy: a retrospective evaluation of 372 cases

Purpose: The objective of this study was to evaluate the palliation of pain of bone metastases with biphoshonates and different radiotherapy protocols, in 372 cancer patients. Patients and methods: Patients were treated with one of the 3 different radiotherapy protocols: 30 Gy in 10 fractions (group A), 20 Gy in 5 fractions (group B) and 8 Gy in a single fraction (group C). Two patient groups were studied: one with radiotherapy alone and the second with biphosphonates plus radiotherapy. The severity of pain was recorded before treatment. According to the pain relief, two different groups were defined: palliation rate < 50% (limited palliation) and > 50% (partial palliation), including complete pain relief. Results: Overall limited and partial palliation rates were 20.2 and 79.8%, respectively (complete pain palliation 24.2%). In the group treated with both external radiotherapy and biphosphonates, limited and partial palliation rates were 19.5 and 80.4%, respectively (p=0.47). For 244 metastatic lesions treated with palliative radiotherapy alone, limited palliation rate was 20.4% and partial palliation rate 79.5%. No differences were detected between the groups with or without bithosphonates treatment in terms of pain palliation. According to the radiotherapy protocol, limited palliation rates in groups A, B, and C were 17.7, 20.3, and 28.5%, respectively (p=0.19, p=0.38, and p=0.26, respectively). Partial palliation rates were 82.2% in group A, 79.6% in group B and 71.4% in group C (p=0.42, p=0.21, and p=0.11, respectively). Similarly, no statistically significant differences were detected among the 3 radiotherogy schemes in terms of pain palliation. Conclusion: When combined with palliative radiotherapy, biphosphonates did not have any additive effects on pain palliation in the management of painful bone metastases. In addition, a single radiotherapy fraction provides equal pain palliation as multiple fractions.