A single dose of radiation to treat bone pain due to the spread of cancer appears to be as effective as multiple doses of radiation, and may be more cost effective, according to a new study.

Researchers evaluated data from a Dutch study published several years ago, looking specifically at the costs associated with treatment. Wilbert van den Hout, PhD, from Leiden University Medical Center, Netherlands, and colleagues reported their results in the Journal of the National Cancer Institute (Vol. 95: 222-229).

Doctors have long used external radiation therapy (radiation directed at the body from a machine) as a means of controlling bone pain due to cancer. It is effective as long as a limited number of areas are involved and they are accessible to radiation delivery. When many areas are involved, newer forms of radiotherapy may be useful, such as radiopharmaceuticals – radioactive drugs injected into a vein.

While doctors know radiation therapy can be effective in most people, determining the best dose to use and the best way to give this dose has been difficult. Because of the concerns of side effects with large, single doses of radiation, doctors have developed “fractionated” regimens – giving smaller doses of radiation on consecutive days. This has allowed larger doses to be given overall.

Some large studies in the past have reported that more people responded to such multiple-dose strategies. Many doctors now use such techniques to treat bone pain.

The researchers reported the initial results of the Dutch Bone Metastasis Study in 1999. The study included data from more than 1,100 patients with cancer that had spread to bone. The patients were treated at the site of spread with either a single large dose of radiation or smaller doses of radiation given over six days.

There was no difference between the two groups in terms of pain reduction, side effects, or other quality of life measures. Those in the single dose group were more likely to need a second round of treatment, but even when this was needed they required fewer treatment sessions overall.

In the current look at this study, the authors focused on the costs associated with the two techniques.

There were no differences in terms of life expectancy, even when considering the quality of life offered by the two treatments. The estimated medical and non-medical costs, however, were lower in the single-dose group.

The single-dose regimen was also more favorable in terms of cost to society. For instance, the decreased number of treatments that radiation therapy departments needed to give would open up the schedule for others in need, according to the authors.

“Compared with multiple-fraction therapy, single-fraction therapy provides equal palliation to patients and reduces the number of journeys to the hospital,” the authors concluded. “Single-fraction therapy is more easily included into departmental schedules, reducing both medical and societal costs and saving treatment capacity for other patients.”

At the same time, however, they pointed out that some factors, such as the cost estimates, might not apply in countries such as the US. “The reliability of these estimates may be less for radiotherapy institutions outside The Netherlands because costs can vary substantially by country or even by radiotherapy institution.”