Sze W M, Shelley M D, Held I, Wilt T J, Mason M D
Departament of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, PR China.
Clin Oncol (R Coll Radiol). 2003 Sep;15(6):345-52. doi: 10.1016/s0936-6555(03)00113-4.
Recent randomised studies have reported that single fraction radiotherapy is as effective as multifraction radiotherapy in relieving pain caused by bone metastasis. However, there are concerns about the higher re-treatment rates and the efficacy of preventing future complications, such as pathological fracture and spinal cord compression, by single fraction radiotherapy. A systematic review of randomised studies, examining the effectiveness of single fraction radiotherapy versus multiple fraction radiotherapy for metastatic bone pain relief and prevention of bone complications, was conducted to help answer this controversy. Randomised studies comparing single fraction radiotherapy with multifraction radiotherapy on metastatic bone pain were identified. The analyses were performed using intention-to-treat principle. The results were pooled using meta-analysis to estimate the effect of treatment on pain response, re-treatment rate, pathological fracture rate and spinal cord compression rate. Twelve trials involving 3621 sites were included in the meta-analysis. The overall pain-response rates for single fraction radiotherapy and multifraction radiotherapy were 60% (1080/1814) and 59% (1060/1807), respectively, giving an odds ratio (OR) of 1.03 (95% confidence interval [CI] 0.90-1.19), indicating no difference between the two radiotherapy schedules. There was also no difference in complete pain response rates for single fraction radiotherapy (34% [508/1476]) and multifraction radiotherapy (32% [475/1473]), with an OR of 1.10 (950% CI 0.94-1.30). Patients treated by single fraction radiotherapy had a higher re-treatment rate, with 21.5% (267/1240) requiring re-treatment compared with 7.4% (91/1236) of patients in the multifraction radiotherapy arm (OR 3.44 [95% CI 2.67-4.43]). The pathological fracture rate was also higher in single fraction radiotherapy arm patients. Three per cent (37/1240) of patients treated by single fraction radiotherapy developed pathological fracture compared with 1.6% (20/1236) for those treated by multifraction radiotherapy (OR 1.82 [95% CI 1.06-3.11]). The spinal cord compression rates were similar for both arms (OR 1.41 [95% CI 0.72-2.75]). Single fraction radiotherapy was as effective as multifraction radiotherapy in relieving metastatic bone pain. However, the re-treatment rate and pathological fracture rate were higher after single fraction radiotherapy. Studies with quality of life and health economic end points are warranted to find out the optimal treatment option.
近期的随机研究报告称，单次分割放射治疗在缓解骨转移引起的疼痛方面与多次分割放射治疗效果相当。然而，人们担心单次分割放射治疗的再次治疗率较高，以及在预防未来并发症（如病理性骨折和脊髓压迫）方面的疗效。为了帮助解答这一争议，对随机研究进行了系统综述，以检验单次分割放射治疗与多次分割放射治疗在缓解转移性骨痛和预防骨并发症方面的有效性。确定了比较单次分割放射治疗与多次分割放射治疗对转移性骨痛疗效的随机研究。分析采用意向性治疗原则进行。结果通过荟萃分析进行汇总，以评估治疗对疼痛反应、再次治疗率、病理性骨折率和脊髓压迫率的影响。荟萃分析纳入了12项涉及3621个部位的试验。单次分割放射治疗和多次分割放射治疗的总体疼痛缓解率分别为60%（1080/1814）和59%（1060/1807），优势比（OR）为1.03（95%置信区间[CI]0.90 - 1.19），表明两种放射治疗方案之间无差异。单次分割放射治疗（34%[508/1476]）和多次分割放射治疗（32%[475/1473]）的完全疼痛缓解率也无差异，OR为1.10（95%CI 0.94 - 1.30）。接受单次分割放射治疗的患者再次治疗率较高，21.5%（267/1240）需要再次治疗，而多次分割放射治疗组为7.4%（91/1236）（OR 3.44[95%CI 2.67 - 4.43]）。单次分割放射治疗组患者的病理性骨折率也较高。接受单次分割放射治疗的患者中有3%（37/1240）发生病理性骨折，而接受多次分割放射治疗的患者为1.6%（20/1236）（OR 1.82[95%CI 1.06 - 3.11]）。两组的脊髓压迫率相似（OR 1.41[95%CI 0.72 - 2.75]）。单次分割放射治疗在缓解转移性骨痛方面与多次分割放射治疗效果相当。然而，单次分割放射治疗后的再次治疗率和病理性骨折率较高。有必要开展以生活质量和卫生经济学为终点的研究，以找出最佳治疗方案。
