• Pierfrancesco Franco, Fernanda Migliaccio, Veronica Angelini, Domenico Cante, Piera Sciacero, Andrea Peruzzo Cornetto, Valeria Casanova Borca, Michele Zeverino, Paolo Torielli, Cecilia Arrichiello, Giuseppe Girelli, Maria Rosa La Porta, Santi Tofani, Gianmauro Numico, and Umberto Ricardi.
• Department of Radiation Oncology, Tomotherapy Unit,1.
• Cancer Invest. 2014 Nov 1; 32 (9): 458-63.

PurposeTo evaluate the feasibility and response to palliative radiotherapy delivered with static ports of tomotherapy--TomoDirect (TD) in patients affected with painful bone metastases from solid tumors.MethodsA prospective cohort of 130 patients (185 osseous lesions) was treated between 2010 and 2013 with TD. Three fractionation schedules were employed according to clinical decision-making (3 Gy × 10; 4 Gy × 5; 8 Gy × 1). Pain response was investigated at 2 weeks and 2 months (for evaluable patients). The Numeric Rating Scale (NRS-11) was used to assess pain. Response rates to radiotherapy were calculated following the criteria of the International Bone Metastases Consensus Group (IBMCG), accounting for the use of concomitant analgesics (response: complete or partial; non-response: stable pain, pain progression or "other"). Analgesic consumption was recalculated into the daily oral morphine-equivalent dose (OMED).ResultsMost of the patients had 1-2 bone metastases (91); those with multiple lesions mostly had a metachronous presentation (60%). Synchronous lesions were mainly approached with multiple plans (63%). Most treatments employed 3-4 fields (77%). Treatment times ranged from 255 to 939 s depending on fractionation, fields, and target lesions number. At 2 weeks, the median self-reported worst pain decreased significantly as median oral morphine-equivalent dose regardless of fractionation used. The response rate according to the IBMCG-based response categories ranged from 45 to 55%. Pain relief duration seems (response at 2 months) slightly inferior with the single fraction approach, with a higher re-treatment rate. At 2 weeks, the median self-reported worst pain and OMED significantly decreased regardless of fractionation (response rate: 49-55%). Pain relief decreased at 2 months, especially for single fraction (higher re-treatment rate).ConclusionTD is a valid option to deliver palliative radiotherapy for painful bone metastases from solid tumors.

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