New Standard of Care for Painful Bone Metastases

http://www.medscape.com/viewarticle/448886
Laurie Barclay, MD

Feb. 4, 2003 — Single-fraction radiotherapy for painful bone metastases
was equally efficacious and less expensive than multiple-fraction therapy,
according to the results of a randomized societal cost-utility analysis
published in the Feb. 5 issue of the Journal of the National Cancer
Institute. The investigators suggest that this should be the standard of
care for palliation.

"Although single- and multiple-fraction radiotherapy are thought to
provide equal palliation, which treatment schedule provides better value
for the money is unknown," write Wilbert B. van den Hout, PhD, from the
Leiden University Medical Center in the Netherlands, and colleagues from
the Dutch Bone Metastasis Study Group.

The authors performed a cost-utility analysis on the Dutch Bone Metastasis
Study, in which 1,157 patients with painful bone metastases were
randomized to receive either a single-fraction radiotherapy schedule of 8
Gy or a multiple-fraction radiotherapy schedule of six fractions of 4 Gy
each.

There was no difference in life expectancy between the two groups (43.0
weeks for the single-fraction schedule vs. 40.4 weeks for the
multiple-fraction schedule; P = .20), nor was there a difference in
quality-adjusted life expectancy (17.7 vs. 16.0 weeks; P = .21).

Compared with single-fraction radiotherapy, multiple-fraction radiotherapy
was more expensive when retreatment costs and other patient costs were
included ($3,311 vs. $2,438; difference, $873; 95% confidence interval,
$449 - $1,297; P < .001). The estimated difference in total societal costs
also favored single-fraction radiotherapy, but the difference was not
statistically significant.

All Dutch institutions have now adopted single-fraction radiotherapy as
standard treatment of painful bone metastases. "Compared with
multiple-fraction therapy, single-fraction therapy provides equal
palliation and quality of life and has lower medical and societal costs,
at least in the Netherlands," the authors write. "Therefore,
single-fraction radiotherapy should be considered as the palliative
treatment of choice for cancer patients with painful bone metastases."

J Natl Cancer Inst. 2003;95:222-229

Reviewed by Gary D. Vogin, MD