Single fraction conventional external beam radiation therapy for bone metastases: A systematic review of randomised controlled trials
Bibliographic record
Abstract
PURPOSE: To determine the optimal dose of single fraction conventional palliative radiation therapy for the relief of pain caused by bone metastases. MATERIAL AND METHODS: Ovid version of EMBASE and EMBASE Classic, MEDLINE, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched for relevant randomised controlled trials. Pain response data were standardised according to the clinical trial endpoints recommended by the International Bone Metastases Consensus Working Party. RESULTS: From 2696 references we selected 26 articles for review. These described 24 trials that cumulatively randomised 3233 patients to 28 single fraction arms: two arms received 4 Gy, one 5 Gy, one 6 Gy, twenty-two 8 Gy, one 10 Gy and one 8-15 Gy. Eighty-four percent of all patients received 8 Gy and this imbalance precluded formal modelling analyses for different doses. Efficacy endpoints and pain assessment times varied. In general, higher doses produced better pain response rates. The overall (OR) and complete (CR) pain response rates for different doses according to available intention-to-treat (ITT) and assessable patient (A) figures were: 4 Gy [OR(ITT)=23-47%, OR(A)=44-47%, CR(ITT)=15-18%, CR(A)=15-26%], 5 Gy [OR(A)=72%, CR(A)=55%], 6 Gy [OR(ITT&A)=65%, CR(ITT&A)=21%], 8 Gy [OR(ITT)=21-81%, OR(A)=31-93%, CR(ITT)=9-52%, CR(A)=14-57%], 10 Gy [OR(A)=84%, CR(A)=39%]. In trials that directly compared different single fraction doses, 8 Gy was statistically superior to 4 Gy. CONCLUSIONS: 8 Gy was by far the most commonly administered single fraction dose within 24 randomised trials of conventional radiation therapy for the palliation of bone metastases. 8 Gy should be the standard dose against which future treatments are compared due to its reproducible pain response rate and its established safe profile. The optimal dose for the relief of pain remains an open question, however, 8 Gy produced statistically superior pain response rates compared to 4 Gy in trials directly comparing those doses, and in general across all trials doses of 8 Gy or more produced numerically superior pain response rates compared to doses less than 8 Gy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.017 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.010 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".