1. Validity of more than 30Gy radiation therapy for long-surviving patients with painful bone metastases E.Katayama 1,2, H.Okada 1, I.Asakawa 2, T.Tamamoto 2, C.Kajitani 2, K.Furuichi 1, A.Okura 1, K.Ide 1, S.Iwasaki 1, M.Hasegawa 2 1 Higashi-Osaka City General Hospital, Higashi-Osaka, Japan 2 Nara Medical University, Kashihara, Japan Introduction Radiation therapy (RT) of 8Gy in a single fraction, 20Gy in 5 fractions, or 30Gy in 10 fractions is the common and standard palliative treatment for painful bone metastases. Re-irradiation is also suggested to be useful for recurrent pain in some long survivors, but the efficacy of the second RT is not always equal to that of the first. Purpose / Objectives To determine whether RT of more than 30Gy for painful bone metastasis is valid for patients who are suggested to be able to survive for 6 months or more, we analyzed the actual survival time of patients treated with radiotherapy according to the estimated survival time. Materials/Methods Between February 2007 and August 2008, 159 patients with painful bone metastasis were treated with radiotherapy in 2 hospitals (77 patients in N and 82 patients in H). Before the treatment, we estimated the patients’ survival time, and determined the radiotherapy schedules. Patients were followed for >12 months or until death, Group L and Group S were compared to evaluate the validity of the protocol. Survival analyses were performed according to the Kaplan-Meier method and the log-rank test. Treatment paradigm Patients with painful bone metastasis Group L ; suggested to survive for 6 months or more : fractionated RT more than 30Gy ; 37.5Gy in 15 fractions, 40Gy in 20 fractions, 50Gy in 25 fractions, etc. Group S; suggested to survive for less than 6months : standard RT 30Gy in 10 fractions or RT less than 30Gy Primary sites Lung Prostate Breast HCC Colon &Rectum RCC Stomach Bladder Esophagus Pancreas Unknown Others Total 29 12 10 6 7 6 4 2 3 5 100 16 11 3 4 3 5 2 0 1 9 59 Group LGroup S Results 1 Median follow-up time : all patients ; 7.2 month / survivors ; 14.3 month Median overall survival time : Group S ; 2.4 months / Group L ; 8.5 months in H 2.9 months / 8.3 months in N 1.2 months / 8.9 months Lung cancer 2.7 months / 7.4 months In both groups of the prostate cancer and breast cancer, median survival time was more than 6 months. Results 2 In both Groups, the essential goals; palliation of the pain prevention of pathologic fracture were achieved. Re-irradiation was necessary for only 1 case of Group L. Kaplan-Meier survival curve Hospital NHospital H NS Survival time (month) Survival rate(%) Lung NS Prostate NS p<0.01 GrouP S GrouP L Survival time (month) References Wu JS,et al. Int J Radiat Oncol Biol Phys 2003;55:594-605 Rades D,et al. Cancer 2008;112:157-161 Mizumoto M,et al. Cancer 2008;113:2816-2822 Katagiri H, et al. J Bone Joint Surg Br. 2005;87:698-703 The patient group that received more than 30Gy for painful bone metastasis survived significantly longer than the other group. This result suggests that the validity of grouping in this study. Additionally, the result suggests that more intense RT than the standard RT may be useful for some limited groups of patients with bone metastasis, but it is difficult to draw the conclusion that the higher dose is more effective than the standard dose from this retrospective study. It is necessary to establish a standard for selection of optimal radiotherapy schedules for patients with painful bone metastases. Conclusions Discussions Although the ultimate prognosis is poor, many patients, particularly those with cancers of the breast and prostate, may survive for many months or even years. Consequently, nearly all will need treatment to relieve the symptoms and signs caused by cancer for the remainder of their lives. Important factors are age, probable survival time, performance status, the conditions of the primary site…etc. The effectiveness of the treatment also depends on the goal as follows : palliation of the pain, prevention of pathologic fracture, avoidance of future treatments, or local control of the disease. The radiation doses and volumes required for each goal will be different. All patients GrouP L Group S Survival time (month)