Reanalysis of the RTOG study of the palliation of symptomatic osseous metastasis

This is a reanalysis of the data from the Radiation Therapy Oncology Group (RTOG) study of the palliation of metastasis to bone. The RTOG multicenter clinical trial studied pain relief in 759 patients randomly assigned to a variety of dose-fractionation schedules: 270 cGy × 15 fractions, 300 × 10, 300 × 5, 400 × 5, and 500 × 5. The multivariate statistical technique of logistic regression was used. The results differed from a previous report in that number of fractions was statistically significantly related to complete combined relief (that is, absence of pain and cessation of the use of narcotics). Also, the time dose factor (TDF) isoeffect conversion did not accurately predict tumor response. The conclusion is that protracted dose-fractionation schedules are more effective than short course schedules.