Palliative Radiation Therapy in Reducing Pain in Patients With Bone Metastasis

Study Overview
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Brief Summary
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This randomized phase II trial studies how well palliative radiation therapy works in reducing pain in patients with cancer that has spread from the original (primary) tumor to the bone (bone metastasis). Palliative radiation therapy using external beam radiation therapy may help patients with bone metastasis to relieve symptoms and reduce pain caused by cancer.

Detailed Description
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PRIMARY OBJECTIVES: I. To determine whether 8 gray (Gy) x 2 fractions results in lower re-treatment rates compared to 8 Gy x 1 fraction. SECONDARY OBJECTIVES: I. To determine whether 8 Gy x 2 fractions provides superior pain and narcotic relief compared to 8 Gy x 1 fraction. II. To determine whether 8 Gy x 2 fractions is associated with improved quality of life compared to 8 Gy x 1 fraction. III. To determine whether use of a bone strengthening agent is associated with improved pain relief, narcotic relief and re-treatment rates. IV. To determine if 8 Gy x 2 fractions is associated with increased toxicity. V. To correlate patient satisfaction, perceived stress, and social support with treatment outcomes. TERTIARY OBJECTIVES: OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients undergo 1 fraction of external beam radiation therapy (EBRT) over 30 minutes. ARM II: Patients undergo 2 fractions of EBRT over 30 minutes. The 2 fractions will be separated by 3-7 days. After completion of study treatment, patients are followed up at 30 days and at 3 months.

Official Title
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A Prospective Randomized Phase II Study of 1 vs 2 Fractions of Palliative Radiation Therapy for Patients With Symptomatic Bone Metastasis

Conditions
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Malignant Neoplasm, Metastatic Malignant Neoplasm in the Bone, Pain

Intervention / Treatment
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* Radiation: External Beam Radiation Therapy
* Radiation: Palliative Radiation Therapy
* Other: Quality-of-Life Assessment
* Other: Questionnaire Administration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of cancer, not including multiple myeloma Radiographic evidence of bone metastases within 8 weeks of study; the patient must have pain which appears to be related to the radiographically documented metastasis in the opinion of the treating physician, and the decision has been made by the responsible clinician that a course of palliative external beam radiation therapy is appropriate treatment; multiple sites eligible if they can be included in no greater than 3 treatment sites Eligible treatment sites are: Weight bearing sites Pelvis (excluding pubis) Femur Sacrum and/or sacroiliac joints Tibia Non-weight bearing sites Up to 5 consecutive cervical, thoracic or lumbar vertebral bodies Lumbosacral spine Up to 3 consecutive ribs Humerus Fibula Radius ± ulna Clavicle Sternum Scapula Pubis If multiple sites are treated, the treatment site is included as weight-bearing if any of the sites include the pelvis, sacrum, femur or tibia Pain score of at least 5 on a scale of 0 - 10 within a week of enrollment OR pain score < 5 with >= 60 mg of morphine (or equivalent) per day Eastern Cooperative Oncology Group (ECOG) performance status of 0 - 3 Ability to understand and the willingness to sign an Institutional Review Board (IRB)-approved informed consent document Negative pregnancy test at study registration Changes in systemic chemotherapy, hormonal therapy or the use of bisphosphonates for 4 weeks before and after the delivery of radiotherapy are allowed, but recording and accounting for this in the statistical analysis is required Life expectancy of at least 12 weeks as deemed by the treating oncologist Patients will be eligible for treatment of multiple osseous sites only if those sites can be included in no more than three treatment sites; for patients with painful metastases that are contiguous but do not fit into the definition of a site listed above, those patients will still be eligible but will be considered to have two treatment sites; for example, a patient with a lesion of T4, T7 and T9 would be eligible but would be considered as two treatment sites since more than five consecutive vertebral bodies would be treated; these lesions could be treated with one field, even though the treatment is coded as two sites Exclusion Criteria: Previous radiotherapy or palliative surgery to the painful site Metastases to the skull, hands, feet are not eligible treatment sites Spinal cord or cauda equine compression/effacement in vertebral metastases with neurological symptoms other than just pain
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ARM I (palliative radiation therapy)<br>Patients undergo 1 fraction of EBRT over 30 minutes. | Radiation: External Beam Radiation Therapy<br>* Undergo EBRT<br>* Other names: external-beam radiation;Radiation: Palliative Radiation Therapy<br>* Undergo EBRT<br>Other: Quality-of-Life Assessment<br>* Ancillary studies<br>* Other names: Quality of Life Assessment;Other: Questionnaire Administration<br>* Ancillary studies<br>|
| Experimental: ARM II (palliative radiation therapy)<br>Patients undergo 2 fractions of EBRT over 30 minutes. The 2 fractions will be separated by 3-7 days. | Radiation: External Beam Radiation Therapy<br>* Undergo EBRT<br>* Other names: external-beam radiation;Radiation: Palliative Radiation Therapy<br>* Undergo EBRT<br>Other: Quality-of-Life Assessment<br>* Ancillary studies<br>* Other names: Quality of Life Assessment;Other: Questionnaire Administration<br>* Ancillary studies<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in narcotic use in daily oral morphine equivalents |  | Baseline to up to 3 months post-treatment | 
| Change in pain intensity assessed using the Numerical Rating Pain Scale | Measured on a continuous scale and will be compared between groups using 2-sample t-tests. | Baseline to up to 3 months post-treatment | 
| Change in quality of life measured using the quality of life questionnaire (QLQ) core(C)15-palliative (PAL) and QLQ-C30 | Analyses will be performed that examine whether there are associations between quality of life and treatment outcome (re-treatment rates or amount of pain relief). Measured on a continuous scale and will be compared between groups using 2-sample t-tests. Either multiple logistic regression (for binary outcomes) models or analysis of covariance (ANCOVA) models for continuous outcomes will be used. | Baseline to up to 3 months post-treatment | 
| Re-treatment rates | The primary analysis will use a one-sided Z-test for proportions to test the null hypothesis. | Up to 3 months post-treatment |