Abstract：
Palliative radiotherapy (RT) effectively relieves pain in patients with bone metastases (BMs). Furthermore, several clinical trials, in most cases conducted in high-income countries (HICs), proved that single-fraction RT is equally effective compared to multi-fractionated RT. However, the evidence is scarce regarding low/middle-income countries (LMICs), where the diagnosis of BMs could be later and RT techniques less advanced. Therefore, we conducted a systematic literature review to evaluate the efficacy of palliative RT of BMs in the LMIC setting. A literature search was performed independently by two authors on the PubMed, Cochrane and Scopus databases. Overall, 333 records were screened and after the selection process, 11 papers were included in the analysis. Complete pain response rates ranged from 11.5% to 37.1% (median: 22%) for single-fraction RT and from 0% to 35.1% (median: 19%) for multi-fractionated RT. Partial pain response rates ranged from 23.1% to 76.9% (median: 53.8%) for single fraction RT and from 23.8% to 84.6% (median: 65%) for multi-fractionated RT. Four randomized trials compared single-fraction RT with multiple-fraction RT and none of them showed significant differences in terms of pain relief. Our analysis showed that pain response rates after palliative RT recorded in LMIC are like those reported in studies performed in HIC. Even in this setting, RT in single fraction shows comparable pain response rates to multifractional RT.
摘要：
姑息性放疗（RT）可有效缓解骨转移（BMs）患者的疼痛。此外，几个临床试验，在大多数情况下，在高收入国家(HIC)进行，证明单馏分RT与多馏分RT相比同样有效。然而,关于中低收入国家(LMICs)的证据很少，在那里，BMs的诊断可能会更晚，而RT技术则不那么先进。因此,我们进行了系统的文献综述,以评估LMIC环境中BMs姑息性RT的疗效.文献检索由两名作者在PubMed上独立进行，Cochrane和Scopus数据库。总的来说,筛选了333条记录，在选择过程之后，11篇论文被纳入分析。单部分RT的完全疼痛缓解率为11.5％至37.1％（中位数：22％），多部分RT的完全疼痛缓解率为0％至35.1％（中位数：19％）。单部分RT的部分疼痛缓解率为23.1％至76.9％（中位数：53.8％），多部分RT的部分疼痛缓解率为23.8％至84.6％（中位数：65％）。四项随机试验比较了单部分RT与多部分RT，但在缓解疼痛方面均无明显差异。我们的分析表明，在LMIC中记录的姑息性RT后的疼痛反应率与在HIC中进行的研究中报道的一样。即使在这种情况下，单一部分的RT显示与多部分RT相当的疼痛反应率。
