COMPARISON OF DIFFERENT RADIATION DOSES FOR PAIN CONTROL IN BONE METASTASIS

Abstract

Background: Painful bone metastases markedly impair quality of life in patients with advanced malignancies. Palliative radiotherapy is a cornerstone of pain management; however, the optimal dose-fractionation schedule remains debated, particularly in high-volume public-sector oncology centres where treatment efficiency and resource utilization are critical. Comparative evaluation of commonly used regimens is therefore clinically relevant. Objective: To evaluate and compare pain response, reduction in analgesic requirements, and re-irradiation rates among patients receiving 20 Gy in 5 fractions, 30 Gy in 10 fractions, and a single 8 Gy fraction for painful bone metastases. Study Design: Retrospective analytical study. Settings: Department of Radiotherapy and Oncology, Nishtar Hospital, Multan. Duration of Study: January 2025 to July 2025. Methods: Clinical records of 110 adult patients with radiologically confirmed painful bone metastases were reviewed. Pain scores and analgesic consumption were documented at baseline, two weeks, and one month following radiotherapy. Pain response was classified as complete, partial, or absent using standard criteria. Outcomes, including pain relief, analgesic reduction, and re-irradiation rates, were compared across the three radiotherapy regimens. Results: Complete pain response was highest in the 20 Gy in 5 fractions group (30%), followed by the 30 Gy in 10 fractions group (26%) and the single 8 Gy fraction group (19%). Partial pain response was most frequently observed with the 30 Gy regimen (63%). Reduction in analgesic requirement was most significant among patients receiving 30 Gy in 10 fractions (76%). The need for re-irradiation was highest in the single-fraction 8 Gy group (22%). Both multifraction regimens provided earlier pain relief than the single-fraction schedule. Conclusion: All three radiotherapy regimens provided clinically meaningful pain relief in patients with bone metastases. However, multifraction schedules were associated with a more consistent early pain response, greater reduction in analgesic use, and lower re-irradiation rates than single-fraction treatment. Given comparable early pain control between the two multifraction regimens, 20 Gy in 5 fractions represents an efficient and pragmatic option for high-volume public-sector oncology centres. At the same time, single-fraction 8 Gy may be reserved for selected patients in whom multifraction treatment is not feasible or rapid palliation is required.