Less is More with This Cancer Therapy

Prostate cancer bone metastasis effectively treated with radiation treatment

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) When cancer spreads to the bones, pain is inevitable. Radiation is used to offer pain relief, but there seems to be some conflict about how much and how often radiation is needed to achieve relief. A recently released study shows less may be more.

Over the past decade, research has shown that prostate cancer patients whose tumors have moved to their bones got just as much relief from a single radiation treatment as those who receive more radiotherapy sessions. Yet “single-fraction” (one session) radiotherapy is not widely used.

According to this recent study, the results of ignoring the evidence have been higher health costs and lower quality of life for patients.

"Ask your oncologist what each cancer therapy is designed to achieve."

Justin E. Bekelman, MD, an assistant professor of Radiation Oncology at the University of Pennsylvania Abramson Cancer Center, and colleagues looked at the practice patterns of palliative (providing comfort only) radiotherapy. Specifically, they looked at single-fraction versus multiple-fraction radiotherapy.

Single-fraction delivers a larger dose of radiation in a single session, whereas multiple-fraction treatment delivers lower doses of radiation in more sessions over longer periods of time.

For this study, the investigators examined the national Surveillance, Epidemiology and End Results (SEER)-Medicare database to find 3,050 advanced prostate cancer patients who’d received palliative radiation treatments between 2006 and 2009.

More than half (50.3 percent) of the patients had more than 10 sessions of radiation, while 3.3 percent received single-fraction treatment.

The costs of providing palliative radiation in one session were significantly lower than multiple session treatment — $1,873 versus $4,967, respectively.

The study authors concluded that “single-fraction treatment has substantial benefits for patient-centric palliative care, including greater quality of life and convenience, reduced travel time, and lower treatment costs."

"This report simply adds further evidence to the data most radiation oncologists already know, that a single (8 Gray) radiation treatment is often as effective as multiple treatments in the management of bone metastases,” said dailyRx Contributing Expert Brian D. Lawenda, MD, clinical director of Radiation Oncology at 21st Century Oncology in Las Vegas.

“Numerous other studies have previously concluded that there is no statistical difference in outcomes regardless of the treatment regimen,” said Dr. Lawenda, who was not involved in this study.

He went on to explain the controversy: “The argument has been that a small number of patients will either have persistent disease or develop a recurrence within the radiated area when using the single treatment regimen versus the longer regimen. However, many of these cases of recurrence or disease persistence can be treated with another single treatment course, if needed."

Dr. Lawenda, who is founder of IntegrativeOncology-Essentials.com, told dailyRx News that just recently the American Society for Radiation Oncology has advised its members to stop giving extended palliative radiation treatments.

This study was published October 7 in JAMA (The Journal of the American Medical Association).

The research was supported by the National Cancer Institute, the American Cancer Society and the Leonard Davis Institute for Health Economics.

Two of the authors reported financial ties with several organizations.

Review Date: 
October 8, 2013
Last Updated:
October 8, 2013