A Cochrane review [Abstract] 1 included 20 studies with a total of 3373 cancer patients with painful bone metastases. Twenty trials reported on 43 RT fractionation schedules and 8 trials were studies of radioisotopes. A total of 2713 patients got radiotherapy (RT) and 660 patients either radioisotope treatment alone or combined with external RT. RT produced complete pain relief at one month in 395/1580 (25%) patients, and at least 50% relief in 788/1933 (41%) patients at some time during the trials. The mode of RT (single or multiple fraction schedules) had no effect on outcomes. The NNT was 4.2 (95% CI 3.7-4.7) to achieve complete relief at one month (compared with an assumed natural history of 1 in 100 patients whose pain resolved without treatment). No pooled estimates of speed of onset of relief, or of its duration, could be obtained. In the largest trial (759 patients) 52% of those who had complete relief had achieved it within 4 weeks, and the median duration of complete relief was 12 weeks. For more generalised disease, radioisotopes produced similar analgesic results to external RT. Adverse effect reporting was poor. There were no obvious differences between the various fractionation schedules in the incidence of nausea and vomiting, diarrhoea or pathological fractures.
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