The management of painful bone metastases with biphosphonates and palliative radiotherapy: a retrospective evaluation of 372 cases

J BUON. Apr-Jun 2009;14(2):245-9.


Purpose: The objective of this study was to evaluate the palliation of pain of bone metastases with biphosphonates and different radiotherapy protocols in 372 cancer patients.

Patients and methods: Patients were treated with one of the 3 different radiotherapy protocols: 30 Gy in 10 fractions (group A), 20 Gy in 5 fractions (group B) and 8 Gy in a single fraction (group C). Two patient groups were studied: one with radiotherapy alone and the second with biphosphonates plus radiotherapy. The severity of pain was recorded before treatment. According to the pain relief, two different groups were defined: palliation rate<50% (limited palliation) and >50% (partial palliation), including complete pain relief.

Results: Overall limited and partial palliation rates were 20.2 and 79.8%, respectively (complete pain palliation 24.2%). In the group treated with both external radiotherapy and biphosphonates, limited and partial palliation rates were 19.5 and 80.4%, respectively (p=0.47). For 244 metastatic lesions treated with palliative radiotherapy alone, limited palliation rate was 20.4% and partial palliation rate 79.5%. No differences were detected between the groups with or without biphosphonates treatment in terms of pain palliation. According to the radiotherapy protocol, limited palliation rates in groups A, B, and C were 17.7, 20.3, and 28.5%, respectively (p=0.19, p=0.38, and p=0.26, respectively). Partial palliation rates were 82.2% in group A, 79.6% in group B and 71.4% in group C (p=0.42, p=0.21, and p=0.11, respectively). Similarly, no statistically significant differences were detected among the 3 radiotherapy schemes in terms of pain palliation.

Conclusion: When combined with palliative radiotherapy, biphosphonates did not have any additive effects on pain palliation in the management of painful bone metastases. In addition, a single radiotherapy fraction provides equal pain palliation as multiple fractions.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Density Conservation Agents / therapeutic use*
  • Bone Neoplasms / drug therapy*
  • Bone Neoplasms / radiotherapy*
  • Bone Neoplasms / secondary
  • Combined Modality Therapy
  • Diphosphonates / therapeutic use*
  • Dose-Response Relationship, Radiation
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain / drug therapy*
  • Pain / etiology
  • Pain / radiotherapy*
  • Pain Measurement
  • Prognosis
  • Retrospective Studies
  • Treatment Outcome


  • Bone Density Conservation Agents
  • Diphosphonates