Elderly Patients with Painful Bone Metastases. The Impact of Comorbidity on the Choice of Radiation Therapy Regimen

Abstract

Background: The aim of this study was to demonstrate comparable pain relief with two schedules of radiotherapy(RT) for painful bone metastases in elderly patients assessed at baseline with the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Materials and methods: 132 elderly were analyzed. 77 received a single 8-Gy fraction and 55 received 20 Gy in 5 fractions. The choice of the treatment schedule was related to comorbidity, disability, target size and compliance. Pain intensity was measured with Numeral Rating Scale (NRS: 0=no pain; 10=high pain). Complete response was defined a pain reduction >3 of three points, partial response as a pain reduction ≥2 (2 ≤ pain reduction ≤ 3), no response was defined by pain score<2. Pain evaluation was recorded at baseline and at 1-4-8 weeks after completing RT. Results: overall response: 90.3% in 8 Gy arm (49.8% complete and 40.5% partial), 94.6% in 20 Gy arm (44.6% complete and 50%partial). No high grade toxicity were reported. The relief of pain was attained faster with single fraction (p-value ~ 0.2). We observed maximum response of pain control after 8 weeks and no significant differences were noted between two groups. The re-treatment rate was 17.6% vs. 11.1% respectively. Conclusions: no significant differences between the two arms in terms of pain response, pain control and toxicity. Our experience showed that not influenced by age, but in the elderly, life expectancy, comorbidities evaluated with the CIRS-G, and compliance, are crucial in selecting of shorter treatment.