Symptomatic relief for patients with osseous metastasis treated with radiation and methylprednisolone: a prospective randomized study

Abstract

A multi-institutional prospective study to evaluate the relief of symptoms for patients with osseous metastasis treated with irradiation and methylpredonisolone was performed. A total of 38 patients with osseous metastasis, treated between January 1991 and December 1992, were included in this study. Patients were randomly allocated to one of two treatments: radiation alone (RT alone) (n = 18) or radiation combined with methylpredonisolone (RT + MP) (n = 20). Symptoms were scored by patients themselves using original Quality of Life (QOL) scores. Stratification by urinary hydroxyproline/creatinine ratios (Hypro/Cr) showed no significant differences in QOL scores between RT and RT + MP in the group with good prognosis, which showed a lower Hypro/Cr (< 3.6 mg/g) during treatment. Following treatment, the score for both groups improved. On the other hand, in the group with poor prognosis, with a higher Hypro/Cr (> or = 3.6 mg/g), a significantly greater improvement in QOL scores was observed for the RT + MP group than for the RT alone group (p < 0.05). There was also a marked difference in the RTOG pain scores, evaluated by physicians before treatment and at the end of treatment, between the two treatment groups and the prognostic groups divided according to Hypro/Cr. No correlation was seen at initial presentation between urinary Hypro/Cr and serum tartrate-resistant acid phosphatase (TrACP). In conclusion, the treatment regimen of RT + MP is recommended for patients with osseous metastasis with poor prognosis who show relatively high Hypro/Cr values. Radiotherapy was equally effective in terms of RTOG pain score for both the poor and good prognostic groups. Serum TrACP was not useful for determining the prognosis of our patient groups.