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10.11.2018 | Original Research | Ausgabe 4/2018 Open Access

Journal of Radiation Oncology 4/2018

Evaluation of effectiveness of palliative radiotherapy for bone metastases: a prospective cohort study

Journal of Radiation Oncology > Ausgabe 4/2018
Joanne M. van der Velden, Yvette M. van der Linden, Anne L. Versteeg, Jorrit-Jan Verlaan, A. Sophie Gerlich, Bart J. Pielkenrood, Nicolien Kasperts, Helena M. Verkooijen
Wichtige Hinweise

Key messages

• Around 60–70% of patients with painful bone metastases experience pain relief after conventional radiotherapy.
• When studying pain response after radiotherapy for bone metastases, leaving out the patients who are lost to follow-up results in response rates that are more favorable.
• Pain scores are lowest at 6 weeks after radiotherapy, after which mean pain scores increase again but are still lower compared to baseline.



Radiotherapy is the standard local treatment for patients with painful bone metastases, but effectiveness has primarily been evaluated in trial populations. The aim of this study was to study pain response to palliative radiotherapy in a prospective cohort of unselected patients with bone metastases.


Patients with painful bone metastases referred to the UMC Utrecht for radiotherapy and enrolled in the PRESENT cohort were included in this study. For all patients, pain response to radiotherapy was assessed, and responders were defined as patients with a complete or partial pain response. Patients with stable pain scores, pain increase, or undetermined response were regarded non-responders. Pain scores obtained at baseline and after 2, 4, 6, 8, and 12 weeks following radiotherapy were obtained. Pain response rates of the total treated population, as well as response rates of the assessable patients, were calculated. To measure the percentage of the remaining time spent with pain relief, the net pain relief (NPR) was calculated by dividing the period of pain relief by the period of survival.


Of the 432 patients enrolled in this study, 262 patients (61%) experienced a complete or partial response. In the 390 assessable patients, this percentage was 67%. Median time to response was 4 weeks (range 1–15 weeks), and the NPR was 64%.


Compared to randomized trial populations, palliative radiotherapy in our unselected patients with bone metastases showed similar pain response rates (61%), with a reasonable duration of this effect.

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