The Comparative Study between 20 Gy in 5 Fractions versus 8 Gy in Single Fraction in Bony Metastasis with Zoledronic Acid

Background: Metastasis is the characteristic feature of primary cancer. Bony metastasis is more commonly seen in breast and prostate carcinomas. The incidence is very high and varies from 65-70%. 40% of patients with bony metastasis experience pain. External beam radiotherapy provides pain relief in 80-90%, with complete pain relief in 50-60% patients. Palliative therapy with zoledronic acid can be given as a single-dose treatment (8 Gy in 1 fraction) and multiple fractions (20 Gy in 5 fractions) for pain relief. Single-fraction treatment has been found advantageous. Hence, the present study was undertaken to compare single and multiple-fraction doses with regard to the response and quality of life in patients with bony metastasis. Methodology: The prospective, randomized, comparative study was conducted during a 1-year study period. 100 patients with primary malignancy were included and randomized to Arm-A (8 Gy in 1 fraction) or Arm-B (20 Gy in 5 fractions). Pain assessment, Quality of Life and functional outcome were assessed. Independent means compared using Unpaired ‘t’ test and proportional comparison done using Fisher’s Exact test. A p value of <0.05 was taken as statistically significant. Results: Pain score in both the groups decreased, but was significantly lower in Arm-A (P < 0.05). Recurrence rate was 8% in Arm-A and 18% in Arm-B, but it was not significant (P > 0.05). Global Health Status showed improvement in both arms, but difference was not significant (P > 0.05). Improvements in physical, role functioning, emotional functioning, social functioning were seen in both arms, but was better in Arm-A. Symptoms scales/items, nausea/vomiting and diarrhea scores also showed improvement in both the arms, but again was better in Arm-A. Conclusion: Palliative radiotherapy with single-fraction treatment was much better as compared to multiplefraction treatments. It was cost effective, required lesser hospital stay and had lower recurrence rate. Pain was better controlled in single-fraction treatment compared to multiple-fraction treatment.