| [Objective] The purpose of this study was to analyze the pain relieving time course in patients with cancerous bone metastasis treated with radiotherapy for cancer pain and to determine differences in pain relief according to primary organ, histopathology,bone metastatic sites, radiation fraction dose, and analgesics, so as to improve clinical treatment.[Methods] We totally collected 86 patients with cancerous bone metasis in Radiotherapy Department of Tumorology Center of Shandong Provincial Hospital from Jan 2008 to Dec 2009. All of those patients were diagnosed cancerous bone metastasis by ECT, X ray or MRI etc. and they were all accompanied with the symptom of pain. Their primary tumor sites include:respiratory system 25 patients, digestive system 24 patients, urogenital system 21 patients, other organs 16 patients. We chose the most painful bone metastatic site as the target for pain evaluation in one patient, in case that the patient had multiple bone metastasis. The sites of bone metastasis included:vertebrate 48 patients, pelvic bone 19 patients, chest bones 13 patients, upper and lower limbs 6 patients. All patients were located under the analog machine first and then radiated in vitro with 6 MV X-ray. The radiation range for atients with vertebrate metastasis is one to two centimeter left and right to the edge of the vertebrate, and one normal vertebrate was included upside and downside the metastatic vertebrate. In the case of a flat or long bone,2-3 cm out of the cancer focous or the whole flat bone was included.All the subjects were conducted with two types of dose fraction radiotherapy according to the estimated life span and pain degree:2 Gy/f* 18 or 20f,5f/w,39 patients; 3 Gy/f* 10 or 12f,5f/w,47 patients. Pain of the irradiated site was assessed using a numerical rating scale (pain score:0 to 10) once a week from the beginning of radiotherapy for 5 weeks(day 0,7,14,21,28,35). The recorded pain scores were statistically analyzed and then the time course curve of pain relief was made. Analyze differences in pain relief according to primary organ, histopathology,bone metastatic sites, radiation fraction dose, and analgesics.[Results] During the time course analysis of the 86 cases, the mean pain scores(±SD) at day 0, day 7, day 14, day 21, day 28, and day 35 were respectively 7.9 (+1.6),5.9 (±2.5),3.6 (±2.5),2.5 (±2.5),1.7 (±2.1), and 1.4 (±1.9), and mean pain score was significantly reduced with time from the start of radiotherapy (P<0.001 repeated measure ANOVA). Mean pain score was significantly reduced every week by d28 (P<0.05:d0 vs. d7, d7 vs. dl4,dl4 vs.d21, and d21 vs. d28). Complete pain relief obtained in 40 (40/86=46.5%) cases, and partial (≥50%) pain relief was obtained in 78(78/86=90.7%) cases. The mean time to obtain 50% pain relief was 10 days. The mean time to obtain complete pain relief (n=40) was 19 days. Doses of analgesics were reduced in 34(34/65=52.3%) cases at the end of radiotherapy. No significant differences were found in the analyses of primary organ, dose/fraction of radiotherapy, histopathology, type of analgesics,and irradiated site (P=0.40,0.57,0.94,0.44, and 0.18,respectively). In the cases that used analgesics(n=64), the dose of analgesics was reduced in 28/64 cases(44%), and the dose of analgesics was not changed in 31/64 cases(47%), and the dose was increased in 6/64 cases(9%).[Conclusion] According to the analysis of pain relieving time in 86 patients with cancerous bone metastasis, we concluded that under the two doses of radiotherapy commonly used clinically(2Gy/f,5 f/w,18f or 20f; 3Gy/f,5f/w, 10f or 12f), pain score could be significantly reduced week by week for 3 to 4 weeks.The results also showed that pain relief by radiotherapy can be obtained independent of the primary organ, histopathologic type, administration of analgesics,dose/fraction, and bone metastatic site.
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