Single-Fraction Radiotherapy and Early Subjective Pain Improvement

The pioneering efforts of the Radiation Therapy Oncology Group protocol 97-14 revealed that 8-Gy single-fraction external beam radiotherapy (EBRT) in patients with breast or prostate cancer provided an equivalent degree of pain relief at 3 months compared with longer fractionation. The National Cancer Institute of Canada Clinical Trials Group Symptom Control Trial SC.23 (NCIC CTG SC.23) built on that experience to reveal that pain flares after 8-Gy single-fraction EBRT can be partially ameliorated with steroid use. The current study is a secondary analysis that suggests that by 2 weeks up to two-fifths of patients may experience pain relief, which may portend improved quality of life (QOL) in patients receiving 8-Gy single-fraction EBRT. Changes in pain and QOL were assessed with validated tools, including the European Organisation for Research and Treatment of Cancer Quality of Life Bone Metastases Module and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative. The current study is a step forward from an earlier study that found early pain relief because all patients in the NCIC CTG SC.23 received the same 8-Gy single-fraction EBRT. Early pain relief may be a surrogate de facto marker of future short-term improved QOL. In fact, the current trial may be immediately beneficial to patients with advanced disease and their respective caregivers and health care practitioners. Furthermore, the NCIC CTG SC.23 observations are candidate metrics that can be incorporated into quality indicators of pain assessment by patients, caregivers, practice guidelines, health care systems, and third-party payers, all of whom are involved in value-based palliative care initiatives.

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