Dose Escalation for Oligometastatic Disease: Is More Better?

Most of the randomized evidence for the optimal radiotherapeutic treatment of metastases was conducted in polymetastatic disease with the goal of symptom management. In particular, for painful bone metastasis, numerous trials have compared various lower dose radiation therapy schedules (eg, 8 Gy × 1, 4 Gy × 5, 3 Gy × 10), with no differences in pain response.1Chow R. Hoskin P. Schild S.E. et al.Single vs multiple fraction palliative radiation therapy for bone metastases: Cumulative meta-analysis.Radiother Oncol. 2019; 141: 56-61Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 2El Hawwari B. Telfah A. Comparison of 8 Gy single fraction radiotherapy versus 20 Gy in five fractions or 30 Gy in 10 fractions for the treatment of metastatic bone pain.Ann Oncol. 2012; 23: ix462Abstract Full Text PDF Google Scholar, 3Malik M. Jilla S. Sesikeran N. et al.Comparison of three different radiation fractionation schedules in the palliation of painful bone metastasis.J Clin Oncol. 2012; 30: 9055Crossref Google Scholar Although the primary goal was met, many showed pain control durability of only 12 weeks and high rates of local failure in the few trials that tracked this outcome.