Background: Bone metastases occur in almost all tumors and it is the third most common site involved by metastasis. Breast and prostate cancer are the most common primary sites metastasising to bone, accounting for up to 70% of total cases. The problems associated with bone metastasis are pain, pathologic fractures, spinal cord compression and hypercalcemia. The prognosis of patients with bone metastases is poor, with median survival ranging from months to few years depending upon site and the presence or absence of visceral metastases. Optimal management of bone metastases requires a multidisciplinary team. Radiotherapy is an integral part of palliation of bone metastasis. Patients who have improvement in pain after radiotherapy may also have improvement in quality-of-life scores.
Purpose: To know the pain relief using Visual Analogue Scale in bone metastasis patients for different fractionation and also to assess the quality of life by EORTC QLQ-C30 module questionnaire
Methods and Materials: A prospective study done on patients with bone metastasis from any primary, whose malignancy was histologically proven and the bone metastasis was confirmed by histology and/ or imaging. Patients who previously received radiation therapy to the region concerned and the presence of any co-morbid conditions to which the patient's symptoms could be attributed to were excluded from the study. It was conducted from September 2013 to April 2015 on sixty patients for pain management and to improve the quality of life in patients receiving palliative radiotherapy. A total of sixty patients were divided in four groups with fifteen patients in each group. Different fractionation of radiotherapy, 8 Gy in single fraction, 20 Gy in 5 fractions, 24 Gy in 6 fractions and 30 Gy in 10 fractions were delivered using Linear accelerator of 6MV photons. Following radiotherapy pain was assessed within the patients of one group and the results were compared with each of the other groups. Pain scale for pre radiotherapy was compared with post radiotherapy at 1 week, 1month and 3 months follow up respectively. By using visual analogue scale and quality of life questonnaire (EORTC QLQ-C30 module) data was analyzed by ANOVA test.
Observations and Results: ANOVA test was used for comparision between each group and the results were considered statistically significant only if p value was < 0.05. Pain relief using visual analogue scale was almost same in all the four groups when compared with each other but there was a significant pain relief in each group when compared to the pre radiotherapy pain scale. P value of performance status was statistically significant in Group B- 0.005 when compared to the other groups. Quality of life, using questonnaire (EORTC QLQ-C30 module), symptomatic scale showed improvement in Group A-0.002, Group C- <0.001 and Group D-<0.001 whereas p value of functional scale was <0.001 in all four groups.
Conclusion: All four fractionation treatment schedules provided significant pain relief and improvement in Quality of life for both symptomatic and functional scale. Therefore consideration of choice of treatment schedule should be based on mean survival and patient convenience.
