COMPARATIVE EVALUATION OF PAIN RELIEF IN METASTATIC LUNG CANCER USING TWO PALLIATIVE RADIOTHERAPY SCHEDULES: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Purpose: Pain is one of the most disabling symptoms in metastatic lung cancer. Hypofractionated external beam radiotherapy (EBRT) is a widely used palliative modality, but the optimal schedule remains debated. This study compared two regimens—30 Gy in 10 fractions versus 20 Gy in 5 fractions—for pain palliation and opioid reduction.

Methods: In this prospective observational study, 96 patients with histologically confirmed metastatic lung carcinoma and moderate-to-severe chest pain were enrolled. Patients received either 30 Gy/10 fractions (Group A, n=48) or 20 Gy/5 fractions (Group B, n=48). Pain intensity was measured using the Brief Pain Inventory (BPI), and opioid use was calculated in morphine milligram equivalent (MME). Assessments were conducted at baseline, 1 month, 3 months, and 6 months after radiotherapy. Logistic regression identified predictors of pain palliation.

Results: Both regimens significantly reduced pain and opioid consumption. At 1 month, 71% of patients achieved partial or complete relief. At 3 and 6 months, ~30% maintained complete relief, with no significant difference between groups. Mean BPI scores declined from 7.9 at baseline to 3.3 at 1 month and remained improved at 6 months (4.2 in Group A, 4.3 in Group B). Opioid use fell from ~26 mg baseline to <5 mg at 6 months. Toxicities were limited to Grade I–II esophagitis, skin erythema, and fatigue. Logistic regression revealed no significant predictors of pain palliation (p>0.05). Conclusions: Both regimens offer equivalent, durable pain palliation with minimal toxicity. The shorter 20 Gy/5 regimen is preferable in advanced disease due to patient convenience and resource efficiency.