E Chow1, L Zeng, N Salvo, K Dennis, M Tsao, S Lutz. 1. Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Ontario, Canada. Edward.Chow@sunnybrook.ca
Abstract
AIMS: To update previous meta-analyses of randomised palliative radiotherapy trials comparing single fractions versus multiple fractions. MATERIALS AND METHODS: All published randomised controlled trials comparing single fraction versus multiple fraction schedules for the palliation of uncomplicated bone metastases were included in this analysis. Odds ratios and 95% confidence intervals were calculated for each trial. Forest plots were created using a random effects model and the Mantel-Haenszel statistic. RESULTS: In total, 25 randomised controlled trials were identified. For intention-to-treat patients, the overall response rate was similar in patients receiving single fractions (1696 of 2818; 60%) and multiple fractions (1711 of 2799; 61%). Complete response rates were 620 of 2641 (23%) in the single fraction arm and 634 of 2622 (24%) in the multiple fraction arm. No significant difference was seen in overall or complete response rates. Pathological fracture did not favour either arm, but spinal cord compression trended towards favouring multiple fractions; however, neither was statistically significant (P = 0.72 and P = 0.13, respectively). Retreatment rates favoured patients in the multiple fraction arm, where the likelihood of requiring re-irradiation was 2.6-fold greater in the single fraction arm (95% confidence interval: 1.92-3.47; P < 0.00001). Repeated analyses excluding drop-out patients did not alter these findings. In general, no significant differences in acute toxicities were seen. CONCLUSION: Overall and complete response rates were similar in both intention-to-treat and assessable patients. Single and multiple fraction regimens provided equal pain relief; however, significantly higher retreatment rates occurred in those receiving single fractions.
AIMS: To update previous meta-analyses of randomised palliative radiotherapy trials comparing single fractions versus multiple fractions. MATERIALS AND METHODS: All published randomised controlled trials comparing single fraction versus multiple fraction schedules for the palliation of uncomplicated bone metastases were included in this analysis. Odds ratios and 95% confidence intervals were calculated for each trial. Forest plots were created using a random effects model and the Mantel-Haenszel statistic. RESULTS: In total, 25 randomised controlled trials were identified. For intention-to-treat patients, the overall response rate was similar in patients receiving single fractions (1696 of 2818; 60%) and multiple fractions (1711 of 2799; 61%). Complete response rates were 620 of 2641 (23%) in the single fraction arm and 634 of 2622 (24%) in the multiple fraction arm. No significant difference was seen in overall or complete response rates. Pathological fracture did not favour either arm, but spinal cord compression trended towards favouring multiple fractions; however, neither was statistically significant (P = 0.72 and P = 0.13, respectively). Retreatment rates favoured patients in the multiple fraction arm, where the likelihood of requiring re-irradiation was 2.6-fold greater in the single fraction arm (95% confidence interval: 1.92-3.47; P < 0.00001). Repeated analyses excluding drop-out patients did not alter these findings. In general, no significant differences in acute toxicities were seen. CONCLUSION: Overall and complete response rates were similar in both intention-to-treat and assessable patients. Single and multiple fraction regimens provided equal pain relief; however, significantly higher retreatment rates occurred in those receiving single fractions.
Authors: Sanders Chang; Peter May; Nathan E Goldstein; Juan Wisnivesky; Kenneth Rosenzweig; R Sean Morrison; Kavita V Dharmarajan Journal: J Palliat Med Date: 2017-11-30 Impact factor: 2.947
Authors: Srinivas Raman; Keyue Ding; Edward Chow; Ralph M Meyer; Yvette M van der Linden; Daniel Roos; William F Hartsell; Peter Hoskin; Jackson S Y Wu; Abdenour Nabid; Rick Haas; Ruud Wiggenraad; Scott Babington; William F Demas; Carolyn F Wilson; Rebecca K S Wong; Liting Zhu; Michael Brundage Journal: Qual Life Res Date: 2017-11-29 Impact factor: 4.147
Authors: Ragnhild Habberstad; M J Hjermstad; C Brunelli; S Kaasa; M I Bennett; K Pardon; P Klepstad Journal: Support Care Cancer Date: 2018-08-13 Impact factor: 3.603
Authors: Yoonsun Chung; Woong Sub Koom; Yong Chan Ahn; Hee-Chul Park; Hak Jae Kim; Sang Min Yoon; Sangjin Shin; Yoon Jae Lee Journal: J Cancer Res Clin Oncol Date: 2013-10-10 Impact factor: 4.553
Authors: Matthew R Callstrom; Damian E Dupuy; Stephen B Solomon; Robert A Beres; Peter J Littrup; Kirkland W Davis; Ricardo Paz-Fumagalli; Cheryl Hoffman; Thomas D Atwell; J William Charboneau; Grant D Schmit; Matthew P Goetz; Joseph Rubin; Kathy J Brown; Paul J Novotny; Jeff A Sloan Journal: Cancer Date: 2012-10-12 Impact factor: 6.860