Palliative Radiation Therapy in Reducing Pain in Patients With Bone Metastasis

PRIMARY OBJECTIVES:

I. To determine whether 8 gray (Gy) x 2 fractions results in lower re-treatment rates compared to 8 Gy x 1 fraction.

SECONDARY OBJECTIVES:

I. To determine whether 8 Gy x 2 fractions provides superior pain and narcotic relief compared to 8 Gy x 1 fraction.

II. To determine whether 8 Gy x 2 fractions is associated with improved quality of life compared to 8 Gy x 1 fraction.

III. To determine whether use of a bone strengthening agent is associated with improved pain relief, narcotic relief and re-treatment rates.

IV. To determine if 8 Gy x 2 fractions is associated with increased toxicity. V. To correlate patient satisfaction, perceived stress, and social support with treatment outcomes.

TERTIARY OBJECTIVES:

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Patients undergo 1 fraction of external beam radiation therapy (EBRT) over 30 minutes.

ARM II: Patients undergo 2 fractions of EBRT over 30 minutes. The 2 fractions will be separated by 3-7 days.

After completion of study treatment, patients are followed up at 30 days and at 3 months.

Inclusion criteria

• Diagnosis of cancer, not including multiple myeloma
• Radiographic evidence of bone metastases within 8 weeks of study; the patient must have pain which appears to be related to the radiographically documented metastasis in the opinion of the treating physician, and the decision has been made by the responsible clinician that a course of palliative external beam radiation therapy is appropriate treatment; multiple sites eligible if they can be included in no greater than 3 treatment sites
• Eligible treatment sites are:

• Weight bearing sites

• Pelvis (excluding pubis)
• Femur
• Sacrum and/or sacroiliac joints
• Tibia
• Non-weight bearing sites

• Up to 5 consecutive cervical, thoracic or lumbar vertebral bodies
• Lumbosacral spine
• Up to 3 consecutive ribs
• Humerus
• Fibula
• Radius ± ulna
• Clavicle
• Sternum
• Scapula
• Pubis If multiple sites are treated, the treatment site is included as weight-bearing if any of the sites include the pelvis, sacrum, femur or tibia
• Pain score of at least 5 on a scale of 0 - 10 within a week of enrollment OR pain score < 5 with >= 60 mg of morphine (or equivalent) per day
• Eastern Cooperative Oncology Group (ECOG) performance status of 0 - 3
• Ability to understand and the willingness to sign an Institutional Review Board (IRB)-approved informed consent document
• Negative pregnancy test at study registration
• Changes in systemic chemotherapy, hormonal therapy or the use of bisphosphonates for 4 weeks before and after the delivery of radiotherapy are allowed, but recording and accounting for this in the statistical analysis is required
• Life expectancy of at least 12 weeks as deemed by the treating oncologist
• Patients will be eligible for treatment of multiple osseous sites only if those sites can be included in no more than three treatment sites; for patients with painful metastases that are contiguous but do not fit into the definition of a site listed above, those patients will still be eligible but will be considered to have two treatment sites; for example, a patient with a lesion of T4, T7 and T9 would be eligible but would be considered as two treatment sites since more than five consecutive vertebral bodies would be treated; these lesions could be treated with one field, even though the treatment is coded as two sites

Exclusion criteria

• Previous radiotherapy or palliative surgery to the painful site
• Metastases to the skull, hands, feet are not eligible treatment sites
• Spinal cord or cauda equine compression/effacement in vertebral metastases with neurological symptoms other than just pain