S865
Clinical - Mixed sites & palliation
ESTRO 2026
dose-escalated IMRT versus conventional 3-D CRT using Mizumoto score for patient stratification Nihal Thokchom 1 , Amitabh Ray 1 , Dilip Kumar Ray 2 , Sayan Kundu 1 , Koustav Majumder 1 , Chandrani Mallik 3 , Bodhisattwa Dutta 1 1 Radiation Oncology, Chittaranjan National Cancer Institute, Kolkata, India. 2 Medical Physics, Chittaranjan National Cancer Institute, Kolkata, India. 3 Medical Oncology, Chittaranjan National Cancer Institute, Kolkata, India Purpose/Objective: To evaluate pain relief and quality of life (QoL) in patients with bone metastases treated with dose- escalated intensity modulated radiation therapy (IMRT) versus conventional 3-D conformal radiation therapy (3-D CRT) employing the Mizumoto score for prognostic stratification Material/Methods: In this study, patients with painful bone metastases were stratified according to the Mizumoto score. 64 patients (Mizumoto Class B or C) with histologically confirmed cancers and radiologically evident bone metastases were randomised to dose-escalated IMRT arm (allowing maximum dose up to 120% within GTV, 95% PTV coverage) and conventional 3-D CRT arm (95% PTV coverage, maximum dose <107%). Both arms received 20 Gy in 5 fractions with daily image guidance.Pain scores and the QoL scores were assessed using the Numerical Pain Rating Scale (NPRS) and the EORTC QLQ-C30 scoring manualrespectively at baseline and at follow-up intervals of 2, 4, 8 and 12 weeks. Results:
reported significant lower pain scores ( p = 0.00001) and higher score in global health status ( p = 0.000025).At the 8-weeks, patients receiving IMRT reported significant lower pain scores (p = 0.0002), insomnia (p=0.00784) and higher global health status (QL2) (p = 0.00000023).At the 12- weeks follow-up, patients receiving IMRT reported significant lower pain scores ( p = 0.00017), dyspnoea (p = 0.01234), insomnia ( p = 0.00954) and higher global health status (QL2) ( p = 0.01085). The pattern of pain reduction was estimated using Restricted Maximum Likelihood (REML) which showed difference between treatment groups, with the dose- escalation not only achieving lower pain score but also maintain a durable response ( p<0.001). Conclusion: Dose-escalated IMRT offers quicker and durable pain palliation for bone metastases. Mizumoto score-based stratification can optimise patient selection and personalise palliative radiotherapy strategies in metastatic cancer care. Keywords: Bone metastases, dose-escalated IMRT, pain relief Digital Poster Highlight 911 Comparison of palliative radiotherapy schedules in non-spine bone metastases with soft-tissue involvement: weekly 0-7-21 versus 24 Gy in six fractions Rupa Das, Thuraya Al Hajri, Sathiya Krishnamoorthy, Jyothy Kalesh Department of Radiation Oncology, Royal Hospital, Muscat, Oman Purpose/Objective: Soft-tissue extension occurs in nearly one-third of non- spine bone metastases (NSBM) and often causes significant pain with less durable responses to conventional palliative radiotherapy than purely osseous disease. Sustained palliation may require a higher biologically effective dose (BED) to control soft- tissue components. The 24 Gy in six fractions regimen remains guideline-endorsed. However, in patients with soft-tissue extension, intermediate performance status, or logistical constraints, a weekly 8 Gy schedule on days 0–7–21 (total 24 Gy in three fractions) may offer a practical alternative with higher BED and fewer visits. This study compares palliative efficacy and local control between these two regimens. Material/Methods: Patients treated between 2021 and 2024 with either weekly 8 Gy × 3 (Days 0–7–21) or conventional 24 Gy in 6 fractions were retrospectively reviewed. Thirty-one
At the specified follow up intervals, significant between-group differences were observed between the two arms. At 2weeks,patients receiving IMRT reported lower pain scores (p = 0.00024) and higher scores in global health status (QL2) (p = 0.010). At 4-weeks, patients receiving IMRT
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