An Evaluation of Pain Response Between Single Fraction Radiotherapy Versus 10 Fractions RT in Metastatic Vertebral Bone Disease: A Quasi Experimental Study

Abstract

The prognosis of bone metastasis is poor, with median survival measured in months, not years. Treatment remains an important issue to alleviate the complications and sufferings of the patients. This study was aimed to evaluate the pain response between single versus multiple fraction radiotherapy in metastatic vertebral bone disease. In this prospective quasi experimental study, the sample consisted of 60 patients of Oncology Dept., KYAMCH. Purposive sampling method was used. The respondents were divided into 2 arms, Arm A consisted of 30 patients, receiving 800 cGy single fraction RT, and Arm B consisted 30 patients who received 3000 cGy multiple fractions RT. The data were collected using a semi-structured questionnaire, which was constructed in line with the reviewed literature along with RECIST (Response Evaluation in Solid Tumor) criteria, VAS (Visual Analogue Scale) after 4 weeks of RT completion and Radiation Therapy Oncology Group (RTOG) criteria. Mean age of Arm A was 43.73 years, and Arm B was 46.8 years. Lung cancer was the leading cancer in both arms, 43.3% and 36.6% respectively. Adenocarcinoma was the commonest histopathological type of cancer found in both arms, 39.9% and 36.6% respectively. To determine associations, Chi-Square tests were done. For Arm A, 66.6% initially presented with severe pain, 23.31% with moderate and 10% with mild pain. In arm B 59.94%, 33.3% and 6.66% patients presented with severe, moderate and mild pain respectively. One month after completion of RT, pain significantly reduced in patients of both arms with a p value of < .001. No significant difference was observed between 8 Gy in single fraction versus 30 Gy in 10 fractions radiotherapy in the management of secondary bone tumour. It was found, both the radiation fractionation schedule for the management of secondary bone tumour are equally effective. More patients can be provided with the desired treatment with shorter period of time. It will certainly ease the economic burden on the patients as well as on the country.