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Clinical Predictors for Analgesic Response to Radiotherapy in Patients with Painful Bone Metastases

Habberstad, Ragnhild; Frøseth, Trude Camilla S.; Aass, Nina; Bjerkeset, Ellen; Abramova, Tatiana; Garcia-Alonso, Elena; Caputo, Mariangela; Rossi, Romina; Boland, Jason W.; Brunelli, Cinzia; Lund, Jo Åsmund; Kaasa, Stein; Klepstad, Pål


Ragnhild Habberstad

Trude Camilla S. Frøseth

Nina Aass

Ellen Bjerkeset

Tatiana Abramova

Elena Garcia-Alonso

Mariangela Caputo

Romina Rossi

Jason W. Boland

Cinzia Brunelli

Jo Åsmund Lund

Stein Kaasa

Pål Klepstad


Background: Radiotherapy (RT) reduces pain in about 60% of patients with painful bone metastases, leaving many patients without clinical benefit. This study assesses predictors for RT effectiveness in patients with painful bone metastases. Materials and methods: We included adult patients receiving RT for painful bone metastases in a multicenter, multinational longitudinal observational study. Pain response within 8 weeks was defined as ≥2-point decrease on a 0−10 pain score scale, without increase in analgesics; or a decrease in analgesics of ≥25% without increase in pain score. Potential predictors were related to patient demographics, RT administration, pain characteristics, tumor characteristics, depression and inflammation (C-reactive protein [CRP]). Multivariate logistic regression analysis with multiple imputation of missing data were applied to identify predictors of RT response. Results: Of 513 eligible patients, 460 patients (90 %) were included in the regression model. 224 patients (44%, 95% confidence interval (CI) 39%−48%) responded to RT. Better Karnofsky performance status (Odds ratio (OR) 1.39, CI 1.15−1.68), breast cancer (OR 2.54, CI 1.12−5.73), prostate cancer (OR 2.83, CI 1.27−6.33) and soft tissue expansion (OR 2.00, CI 1.23−3.25) predicted RT response. Corticosteroids were a negative predictor (OR 0.57, CI 0.37−0.88). Single and multiple fraction RT had similar response. The discriminative ability of the model was moderate; C-statistic 0.69. Conclusion: This study supports previous findings that better performance status and type of cancer diagnosis predicts analgesic RT response, and new data showing that soft tissue expansion predicts RT response and that corticosteroids is a negative predictor for RT response in patients with painful bone metastases.


Habberstad, R., Frøseth, T. C. S., Aass, N., Bjerkeset, E., Abramova, T., Garcia-Alonso, E., …Klepstad, P. (2021). Clinical Predictors for Analgesic Response to Radiotherapy in Patients with Painful Bone Metastases. Journal of pain and symptom management, 62(4), 681-690.

Journal Article Type Article
Acceptance Date Mar 23, 2021
Online Publication Date Mar 29, 2021
Publication Date 2021-10
Deposit Date Nov 22, 2022
Publicly Available Date Nov 24, 2022
Journal Journal of Pain and Symptom Management
Print ISSN 0885-3924
Electronic ISSN 1873-6513
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 62
Issue 4
Pages 681-690
Public URL


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Copyright Statement
© 2021 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
This is an open access article under the CC BY license

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