• Paulien G Westhoff, Alexander de Graeff, Evelyn M Monninkhof, Jacqueline Pomp, Marco van Vulpen, Jan Willem H Leer, Corrie A M Marijnen, Yvette M van der Linden, and Dutch Bone Metastasis Study Group.
• Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: p.g.westhoff@umcutrecht.nl.
• Int. J. Radiat. Oncol. Biol. Phys. 2015 Nov 1; 93 (3): 694-701.

PurposeTo study quality of life (QoL) in responders and nonresponders after radiation therapy for painful bone metastases; and to identify factors predictive for a pain response.Patients And MethodsThe prospectively collected data of 956 patients with breast, prostate, and lung cancer within the Dutch Bone Metastasis Study were used. These patients, irradiated for painful bone metastases, rated pain, QoL, and overall health at baseline and weekly afterward for 12 weeks. Using generalized estimating equations analysis, the course of QoL was studied, adjusted for primary tumor. To identify predictive variables, proportional hazard analyses were performed, taking into account death as a competing risk, and C-statistics were calculated for discriminative value.ResultsIn total, 722 patients (76%) responded to radiation therapy. During follow-up, responders had a better QoL in all domains compared with nonresponders. Patients with breast or prostate cancer had a better QoL than patients with lung cancer. In multivariate analysis, baseline predictors for a pain response were breast or prostate cancer as primary tumor, younger age, good performance status, absence of visceral metastases, and using opioids. The discriminative ability of the model was low (C-statistic: 0.56).ConclusionsResponding patients show a better QoL after radiation therapy for painful bone metastases than nonresponders. Our model did not have enough discriminative power to predict which patients are likely to respond to radiation therapy. Therefore, radiation therapy should be offered to all patients with painful bone metastases, aiming to decrease pain and improve QoL.Copyright © 2015 Elsevier Inc. All rights reserved.

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