Impact of Palliative Radiation Therapy on Quality of Life in Patients with Bone Versus Nonbone Lesions: Secondary Analysis of a Prospective Study.

Abstract

This study compared quality-of-life (QoL) changes following palliative radiation therapy (RT) between patients with painful bone metastases and those with painful nonbone lesions. A total of 440 patients with 678 lesions (541 bone metastases and 137 nonbone lesions) who underwent palliative RT between 2021 and 2023 were included, using the same cohort as a previous study assessing pain response. From 2756 QLQ-C15-PAL/BM22 (Quality of Life Questionnaire Core 15 Palliative/ Bone Metastases Module) questionnaires collected simultaneously with pain assessments, mean scores for each C15-PAL (Core 15 Palliative) subscale at baseline and 2, 4, and 12 weeks post-RT were analyzed. The primary endpoint was the difference in mean change in global health status (GHS)/QoL scores from baseline to 12 weeks between the groups. Secondary endpoints included the differences in other subscales and the improvement rates in each subscale. The median follow-up time was 21 weeks for pain response and 13 weeks for QoL. Baseline QoL data were available for 97% (656/678) of lesions and 74% (338/458) at 12 weeks, with no significant difference between the groups. At baseline, the nonbone group had better GHS/QoL (45 vs 39, P = .015) and physical functioning (76 vs 67, P = .02), but slightly worse scores in the pain subscale (52 vs 51, P = .005). At 12 weeks, no significant differences were observed between the groups across all QoL subscales, including GHS/QoL (52 vs 49, P = .41). Regarding changes over time, dyspnea worsened in the bone metastasis group (+9 vs +1, P = .017), while changes in GHS/QoL (+5 vs +1, P = .27) and other subscales were not significantly different. Improvement rates across all subscales, including GHS/QoL (39% vs 48%, P = .44), were not significantly different between groups. The results of this study indicate that QoL changes after palliative RT for nonbone lesions are comparable to those for bone metastases, providing a basis for future development in this underexplored area.