# Dutch Bone Metastasis Study

Source: https://onco.cc/trials/dutch-bone-metastasis-study/  
OnCo record `dutch-bone-metastasis-study` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

One dose of radiotherapy relieves the pain of a bone secondary as well as six, which means one journey to hospital instead of six.

## Summary

Painful bone metastases are common in lung cancer and radiotherapy relieves them in most patients. The question was whether a longer course works better. The Dutch Bone Metastasis Study randomised patients with painful bone metastases to a single 8 Gy fraction or 24 Gy in multiple fractions. The single-fraction arm had a much higher retreatment rate, 24 against 6 percent, which raised the suspicion that its apparent equivalence was an artefact of retreatment.

The 2004 reanalysis separated response to initial treatment from response to retreatment. Response to initial treatment was 71 percent after a single fraction against 73 percent after multiple fractions (p=0.84); allowing for retreatment raised the single-fraction figure to 75 percent while the multiple-fraction figure was unchanged (p=0.54). Response status after initial treatment did not predict who was retreated: 35 percent of single-fraction non-responders were retreated against 8 percent of multiple-fraction non-responders, and 22 against 10 percent of those with progressive pain. Randomisation arm and pain score before retreatment, not need, predicted retreatment, and retreatment worked in 63 percent of those who received it.

The practical conclusion is that a single 8 Gy fraction is the default for uncomplicated painful bone metastases, and that doctors, not the evidence, were the reason for the retreatment gap.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-25
- Also known as: DBMS; Single fraction versus multiple fraction radiotherapy for painful bone metastases
- Phase: 3
- Setting: Painful bone metastases: a single 8 Gy fraction versus 24 Gy in multiple fractions, with pain response as the endpoint and retreatment permitted in both arms
- Sponsor: Dutch Bone Metastasis Study Group
- Enrolled: 1157
- Result: Pain response to initial treatment 71 percent after a single 8 Gy fraction against 73 percent after 24 Gy in multiple fractions (p=0.84); retreatment raised the single-fraction figure to 75 percent.
- Outcomes: Pain response to initial treatment: 8 Gy single fraction 71% vs 24 Gy in multiple fractions 73%
- Replication: Reproduced by multiple randomised trials and by the systematic reviews that followed; single-fraction treatment is the international standard for uncomplicated painful bone metastases.

## Sources

- Dutch Bone Metastasis Study reanalysis (International Journal of Radiation Oncology, Biology, Physics 2004): https://doi.org/10.1016/j.ijrobp.2003.10.006

## Connected records

- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/)
- technologies: [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [Palliative radiotherapy](https://onco.cc/technologies/palliative-radiotherapy/)
- terms: [Bone metastases and skeletal-related events](https://onco.cc/terms/bone-metastases/), [Palliation in lung cancer: breathlessness, pleural effusion, blocked airway, bone and brain](https://onco.cc/terms/lung-palliation-breathlessness-effusion-obstruction/), [Palliative](https://onco.cc/terms/palliative-treatment/)

---
JSON: https://onco.cc/api/v1/entities/dutch-bone-metastasis-study.json