
Efficacy of External Beam Radiotherapy with Concurrent Capecitabine versus Radiotherapy alone for the Treatment of Painful Bone Metastasis in Primary Breast Cancer Patients: A Prospective Interventional Study
Correspondence Address :
Dr. Manoranjan Meher,
Senior Resident, Department of Radiation Oncology, Acharya Harihar Post Graduate Institute of Cancer, Cuttack-753007, Odisha, India.
E-mail: manathecool@gmail.com
Introduction: The development of widespread distant metastasis, including skeletal metastasis, is common among breast carcinoma patients, irrespective of multimodal treatment. Symptomatic skeletal metastasis is usually treated with External Beam Radiotherapy (EBRT). Capecitabine can act as a radiosensitiser antineoplastic drug and can be added concurrently with EBRT.
Aim: To compare the safety and efficacy of EBRT with concurrent capecitabine against EBRT alone in pain control of painful bone metastasis.
Materials and Methods: This prospective interventional study was conducted in the Department of Radiation Oncology at Acharya Harihar Postgraduate Institute of Cancer, Cuttack, Odisha, India from September 2022 to March 2024. Histologically proven breast cancer patients with painful bone metastasis were included and randomly assigned to group A, receiving palliative radiotherapy only (n=20), and group B, receiving palliative radiotherapy with concurrent capecitabine (n=22). Radiotherapy was administered at a dose of 30 Gy in 10 fractions at 3 Gy per fraction over two weeks. The patients were assessed once weekly during the treatment and at the end of the treatment, patients were evaluated every four weeks until 12 weeks. Response to treatment was evaluated using the Visual Analog Scale (VAS) and analgesic score. Statistical Package for the Social Sciences (SPSS) Version 21.0 (Armonk, NY: IBM Corp) was used for data analysis.
Results: The mean age was 49.90 years for group A and 46.36 years for group B, respectively. The median pain score was 7 (4-10) in group A and 8 (5-9) in group B at baseline; at the end of 12 weeks, it was 2.5 (0-9) for group A and 0 (0-5) for group B (p-value=0.024). All the patients exhibited some level of response at the end of 12 weeks, with a Complete Response (CR) observed in 4 (20%) patients in group A, whereas it was seen in 14 (63.6%) patients in group B (p-value=0.004). Furthermore, there was a decrease in the consumption of analgesics in both groups from week 0 to week 4, with the median analgesic score changing from 2 (1-4) to 1 (0-3) in group A and from 3 (1-4) to 1 (0-2) in group B, without any significant difference between the groups (p-value=0.786).
Conclusion: In comparison to radiotherapy alone, concurrent chemoradiation offers superior pain control and response rates in breast cancer patients with painful bone metastasis. Therefore, capecitabine administered concurrently with radiotherapy is safe for managing painful bone metastasis.
Breast malignancy, Chemoradiation, Response, Skeletal metastasis, 5-flouracil prodrug
DOI: 10.7860/JCDR/2025/79353.21051
Date of Submission: Mar 14, 2025
Date of Peer Review: Mar 23, 2025
Date of Acceptance: Apr 19, 2025
Date of Publishing: Jun 01, 2025
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 17, 2025
• Manual Googling: Mar 21, 2025
• iThenticate Software: Apr 17, 2025 (22%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com