Update of the systematic review of palliative radiation therapy fractionation for bone metastases

• Published in: Radiotherapy and oncology 2018-03, Vol.126 (3), p.547-557
• Main Authors: Rich, Shayna E., Chow, Ronald, Raman, Srinivas, Liang Zeng, K., Lutz, Stephen, Lam, Henry, Silva, Maurício F., Chow, Edward
• Format: Article
• Language: English
• Subjects: Bone metastases; Bone Neoplasms - radiotherapy; Bone Neoplasms - secondary; Cancer Pain - radiotherapy; Dose Fractionation, Radiation; Female; Humans; Meta-analysis; Palliative Care - methods; Palliative radiation; Randomized Controlled Trials as Topic; Randomized trials; Systematic review
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2018.01.003

Radiation therapy is an effective modality for pain management of symptomatic bone metastases. We update the previous meta-analyses of randomized trials comparing single fraction to multiple fractions of radiation therapy in patients with uncomplicated bone metastases. A literature search was conducted in Ovid Medline, Embase, and Cochrane Central Register. Ten new randomized trials were identified since 2010, five with adequate and appropriate data for inclusion, resulting in a total of 29 trials that were analyzed. Forest plots based on each study’s odds ratios were computed using a random effects model and the Mantel–Haenszel statistic. In intention-to-treat analysis, the overall response rate was similar in patients for single fraction treatments (61%; 1867/3059) and those for multiple fraction treatments (62%; 1890/3040). Similarly, complete response rates were nearly identical in both groups (23% vs 24%, respectively). Re-treatment was significantly more frequent in the single fraction treatment arm, with 20% receiving additional treatment to the same site versus 8% in the multiple fraction treatment arm (p