Aoki Yuki, Nakayama Michihiro, Nakajima Kaori, Yamashina Masaaki, Okizaki Atsutaka
Department of Radiology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
Rep Pract Oncol Radiother. 2023 Aug 28;28(4):506-513. doi: 10.5603/RPOR.a2023.0054. eCollection 2023.
Palliative radiotherapy for bone metastases utilizes various dose fractionation schedules. The pain-relieving effects of a single fraction (SF) and multiple fractions (MF) are largely debated due to the difficulty in matching patients' backgrounds and in assessing the effectiveness of pain relief. This study aimed to compare the pain-relieving effects of SF and MF palliative radiotherapy for bone metastases using propensity score matching and the international consensus endpoint (ICE).
Our study included 195 patients irradiated for bone metastasis. The primary endpoint was the pain-relieving effects used by ICE. In addition, the evaluation was performed by using responder (complete response/partial response) and non-responder (pain progression/indeterminate response) categorization. The secondary endpoints were the discharge or transfer rate at one month after irradiation and postirradiation pathological fracture rate. Propensity score matching was used to adjust patient's characteristics and reduce selection bias.
After adapting propensity score matching, the total number of patients was 74. There was no significant difference in the pain-relieving effects between SF and MF (p = 0.184). There were no significant differences in them between SF and MF when using responder and non-responder categorization (p = 0.163). Furthermore, there were no differences in the discharge or transfer rates (p = 0.693) and pathological fracture rates (p = 1.00).
The combination of propensity score matching and ICE revealed no significant difference in the pain-relieving effects between SF and MF for bone metastases, thus, SF has no significant disadvantage compared to MF in pain-relieving effects.
骨转移瘤的姑息性放疗采用多种剂量分割方案。由于难以匹配患者背景以及评估疼痛缓解效果，单次分割（SF）和多次分割（MF）的止痛效果存在很大争议。本研究旨在使用倾向评分匹配和国际共识终点（ICE）比较SF和MF姑息性放疗对骨转移瘤的止痛效果。
我们的研究纳入了195例接受骨转移瘤放疗的患者。主要终点是ICE所采用的止痛效果。此外，通过反应者（完全缓解/部分缓解）和无反应者（疼痛进展/不确定反应）分类进行评估。次要终点是放疗后1个月的出院或转院率以及放疗后病理性骨折率。采用倾向评分匹配来调整患者特征并减少选择偏倚。
采用倾向评分匹配后，患者总数为74例。SF和MF之间的止痛效果无显著差异（p = 0.184）。在使用反应者和无反应者分类时，SF和MF之间也无显著差异（p = 0.163）。此外，出院或转院率（p = 0.693）和病理性骨折率（p = 1.00）也无差异。
倾向评分匹配和ICE相结合显示，SF和MF对骨转移瘤的止痛效果无显著差异，因此，在止痛效果方面，SF与MF相比没有显著劣势。
