© The Author 2006. Published by Oxford University Press.
CORRESPONDENCE |
Re: Randomized Trial of Short- Versus Long-Course Radiotherapy for Palliation of Painful Bone Metastases
Affiliations of authors: Department of Radiation Oncology (MA) and Department of Medical Oncology (AS, MEK), Gaziantep University Medical School, Gaziantep, Turkey
Correspondence to: Mustafa Adli, MD, Department of Radiation Oncology, Gaziantep University Medical School, Gaziantep 27310, Turkey (e-mail: adli{at}gantep.edu.tr).
Hartsell et al. (1) reported that twice as many patients in the 8-Gy arm had received retreatment as in the 30-Gy arm. Higher rates of retreatment in single-fraction arms have been reported before by Nielsen et al. (2) and Steenland et al. (3). Hartsell et al. proposed that the retreatment rate difference between treatment arms may be the result of physician bias. However, this difference (18% versus 9%) may not be explained simply by physician bias alone—a conclusion also reached by Kachnic and Berk (4) in an accompanying editorial. Although van der Linden et al. (5) reported no relation between response to initial treatment and occurrence of retreatment and reached the same conclusion about the role of physician bias, many other factors in addition to bias, some of which were analyzed before (5), such as primary site, involvement and treatment of bone metastases, presence or absence of fracture, pain severity, duration of symptoms, and other treatments received, may affect the decision to retreat. Consequently, a group of patients who do not benefit from a single 8-Gy fraction may need retreatment. It may be helpful to analyze patients treated with a single 8-Gy fraction to define the characteristics of patients who needed retreatment. If any characteristics are statistically significantly associated with retreatment, then the group of patients who need retreatment when treated with a single fraction may be defined and treated with conventional fractionation.
NOTES
Editor's note: Dr. Kachnic declined our invitation to respond.
REFERENCES
(1) Hartsell WF, Scott CB, Bruner DW, Scarantino CW, Ivker RA, Roach M 3rd, et al. Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst 2005;97:798–804.
(2) Nielsen OS, Bentzen SM, Sandberg E, Gadeberg CC, Timothy AR. Randomized trial of single dose versus fractionated palliative radiotherapy of bone metastases. Radiother Oncol 1998;47:233–40.[CrossRef][Web of Science][Medline]
(3) Steenland E, Leer JW, van Houwelingen H, Post WJ, van den Hout WB, Kievit J, et al. The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study. Radiother Oncol 1999;52:101–9.[CrossRef][Web of Science][Medline]
(4) Kachnic L, Berk L. Palliative single-fraction radiation therapy: How much more evidence is needed? J Natl Cancer Inst 2005;97:786–8.
(5) van der Linden YM, Lok JJ, Steenland E, Martijn H, van Houwelingen H, Marijnen CAM, et al. Single fraction radiotherapy is efficacious: a further analysis of the Dutch Bone Metastasis Study controlling for the influence of retreatment. Int J Radiat Oncol Biol Phys 2004;59:528–37.[CrossRef][Web of Science][Medline]
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J Natl Cancer Inst 2006 98: 365.
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