Skip to main content

Advertisement

Log in

Randomised study of single dose (8 Gy vs. 6 Gy) of analgesic radiotherapy plus zoledronic acid in patients with bone metastases

  • Research Articles
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Objective

To assess the effectiveness of a single dose of radiotherapy (8 Gy vs. 6 Gy) plus zoledronic acid in cancer patients with bone metastases in treating pain; quality of life, time to onset of skeletal events and functional status.

Material and methods

A total of 139 patients from 22 Spanish hospitals were randomly assigned to: Group A, administered a single dose of 8 Gy+zoledronic acid (4 mg iv, in 15-min infusions), and Group B, administered a single dose of 6 Gy+zoledronic acid (4 mg iv, in 15-min infusions). The main variable was pain, which was assessed with the Visual Analogue Pain Scale (VAS) in supine, seated and standing positions.

Results

There was a total of 118 patients for intention to treat (n=67 in Group A and n=51 in Group B). The most frequent primary neoplasms were the lung (29.66%), prostate (22.03%) and breast (21.19%). Sixty patients were analysed per protocol, n=34 in group A and n=26 in group B. Improvements were observed in the VAS scores for pain in all three positions. The mean time to onset of the event was greater (p=0.0211) in Group A than in Group B (122 vs. 81.62 days). Functional status improved in Group A, and quality of life improved in both groups.

Conclusion

The two groups achieved similar levels of pain control in supine, seated and standing positions. Quality of life also improved in both groups. However, the higher dose (8 Gy dose) in combination with zoledronic acid is associated with a longer period without skeletal events.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Rubens RD (1998) Bone metastases: the clinical problem. Eur J Cancer 34:210–213

    Article  PubMed  CAS  Google Scholar 

  2. Cole DJ (1989) A randomized trial of a single treatment versus conventional fractionation in the palliative radiotherapy of painful bone metastases. Clin Oncol 1:59–62

    Article  CAS  Google Scholar 

  3. Price P, Hoskin PJ, Easton D et al (1986) Prospective randomized trial of single and multifraction radiotherapy schedules in the treatment of painful bone metastases. Radiother Oncol 6:247–255

    Article  PubMed  CAS  Google Scholar 

  4. Gaze MN, Kelly CG, Kerr GR et al (1997) Pain relief and quality of life following radiotherapy for bone metastases: a randomised trial of two fractionation schedules. Radiother Oncol 45:109–116

    Article  PubMed  CAS  Google Scholar 

  5. Nielsen OS, Bentzen SM, Sandberg E et al (1998) Randomised trial of single dose versus fractionated palliative radiotherapy of bone metastases. Radiother Oncol 47:233–240

    Article  PubMed  CAS  Google Scholar 

  6. Hoskin PJ, Price P, Easton D et al (1992) A prospective randomised trial of 4 Gy or 8 Gy single doses in the treatment of metastasic bone pain. Radiother Oncol 23:74–78

    Article  PubMed  CAS  Google Scholar 

  7. Bone Pain Trial Working Party (1999) 8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomized comparison with a multifraction schedule over 12 months of patient follow-up. Radiother Oncol 52:111–121

    Article  Google Scholar 

  8. Steenland E, Leer JW, van Houwelingen H et al (1999) The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study. Radiother Oncol 52:101–109

    Article  PubMed  CAS  Google Scholar 

  9. Hartsell WF, Scott CB, Bruner DW et al (2005) Randomized trial of short-versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst 97:798–804

    Article  PubMed  Google Scholar 

  10. Roos DE, Turner SL, O’Brien PC et al (2005) Randomized trial of 8Gy in 1 versus 20Gy in 5 fractions of radiotherapy for neuropathic pain due to bone metastases (TROG 96.05). Radiother Oncol 75:54–63

    Article  PubMed  Google Scholar 

  11. Kaasa S, Brenne E, Lund JA et al (2006) Prospective randomised multicenter trial on single fraction radiotherapy (8 Gy?1) versus multiple fractions (3 Gy?10) in the treatment of painful bone metastases. Radiother Oncol 79:278–284

    Article  PubMed  Google Scholar 

  12. McQuay H, Carroll D, Moore RA (1997) Radiotherapy for painful bone metastases: a systematic review. Clin Oncol 9:150–154

    Article  CAS  Google Scholar 

  13. Wu JS-Y, Wong R, Johnston M et al (2003) Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol Biol Phys 55:594–605

    PubMed  Google Scholar 

  14. Sze WM, Shelley MD, Held I et al (2003) Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy d a systemic review of randomised trials. Clin Oncol 15:345–352

    Article  CAS  Google Scholar 

  15. Van Holten-Verzanvoort AT, Bijvoet OL, Cleton FJ et al (1987) Reduced morbidity from skeletal metastases in breast cancer patients during long-term bisphosphonate (APD) treatment. Lancet 2:983–985

    Article  Google Scholar 

  16. Elomaa I, Blomqvist C, Porkka L et al (1985) Diphosphonates for osteolytic metastases. Lancet I:1155–1156

    Article  Google Scholar 

  17. Fulfaro F, Casuccio A, Ticozzi C, Ripamonti C (1998) The role of biphosphonates in the treatment of painful metastatic bone disease: a review of phase III trials. Pain 78:157–169

    Article  PubMed  CAS  Google Scholar 

  18. Body JJ (1997) Clinical research update: zoledronate. Cancer 80[8 Suppl]:1699–1701

    Article  PubMed  CAS  Google Scholar 

  19. Hillner BE, Ingle JN, Berenson JR et al (2000) American Society of Clinical Oncology guideline on the role of bisphosphonates in breast cancer. J Clin Oncol 18:1378–1391

    PubMed  CAS  Google Scholar 

  20. Mundy GR, Wilkinson R, Heath DA (1983) Comparative study of available medical therapy for hypercalcemia of malignancy. Am J Med 74:421–432

    Article  PubMed  CAS  Google Scholar 

  21. Sawyer N, Newstead C, Drummond A, Cunningham J (1990) Fast (4h) or slow (24h) infusions of pamidronate disodium (aminohydroxypropylidene diphosphonate (APD) as single shot treatment of hypercalcaemia. Bone Miner 9:121–128

    Article  PubMed  CAS  Google Scholar 

  22. Body JJ, Borkowski A, Cleeren A, Bijovet OLM (1986) Treatment of malignancy-associated hypercalcemia with intravenous aminohydroxypropylidene diphosphonate. J Clin Oncol 4:1177–1186

    PubMed  CAS  Google Scholar 

  23. Nussbaum SR, Younger J, Vanderpol CJ et al (1993) Single-dose intravenous therapy with pamidronate for the treatment of hypercalcemia of malignancy: comparison of 30, 60 and 90 mg dosages. Am J Med 95:297–304

    Article  PubMed  CAS  Google Scholar 

  24. Lipton A, Berenson J, Levy E et al (1999) Phase II study of the bisphosphonate zoledronate, in patients with osteolytic lesions. Cancer-Induced Bone Diseases. Second International Conference, Davos, Switzerland, March 27–29, 1999. Abstract, no. 48

  25. Green JR, Seltenmeyer Y, Jaeggi KA, Wilder L (1997) Renal tolerability profile of novel, potent bisphosphonates in two short-term rat models. Pharmacol Toxicol 80:225–230

    Article  PubMed  CAS  Google Scholar 

  26. Coleman RE, Seaman JJ (2001) The role of zoledronic acid in cancer. Clinical studies in the treatment and prevention of bone metastases. Semin Oncol 28[2 Suppl 6]:11–16

    Article  PubMed  CAS  Google Scholar 

  27. Borrosch D, Micke O, Schaefer U et al (2001) Combined treatment with radiotherapy and ibandronate for metastatic bone disease. Strahlenther Onkol: 177–198 Department of Radiotherapy and Radiation Oncology, University Hospital, Muenster, Germany

    Google Scholar 

  28. Vassiliou V, Kalogeropoulou C, Christopoulos C et al (2007) Combination ibandronate and radiotherapy for the treatment of bone metastases: clinical evaluation and radiologic assessment. Int J Radiat Oncol Biol Phys 67:264–272

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ana Mañas.

Additional information

The affiliations are listed at the end of the article

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mañas, A., Casas, F., Ciria, J.P. et al. Randomised study of single dose (8 Gy vs. 6 Gy) of analgesic radiotherapy plus zoledronic acid in patients with bone metastases. Clin Transl Oncol 10, 281–287 (2008). https://doi.org/10.1007/s12094-008-0198-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-008-0198-5

Keywords

Navigation