This study was conducted in strict accordance with the ethical principles for medical research involving human subjects outlined in the Declaration of Helsinki. Administrative and institutional authorization to access and analyze the medical records was granted by the management of the Centre Hospitalier Universitaire de Bogodogo (Ouagadougou, Burkina Faso). Owing to the retrospective, non-interventional design of the study utilizing secondary routine clinical data, the requirement for individual written informed consent was waived. Patient confidentiality was strictly preserved; all data were fully anonymized and de-identified using numerical codes prior to statistical analysis traduction.

Fractionation schedule (20 Gy in 5 fractions or 30 Gy in 10 fractions) was selected by the treating radiation oncologist based on performance status. All patients were treated using 3D-conformal radiotherapy and IMRT. Target volume delineation was performed in accordance with the French Society for Radiation Oncology (SFRO) RecoRad™ 2022 guidelines. For standard spinal bone metastases, the clinical target volume (CTV) encompassed the involved vertebra along with the adjacent upper and lower vertebral levels (N ± 1). In the presence of epidural extension (epiduritis), target delineation was modified to extend the CTV longitudinally further above and below the affected segment to ensure full coverage of intraspinal tumor spread. An isotropic expansion margin of 5 to 10 mm was applied to the CTV to construct the planning target volume (PTV) to account for patient positioning and setup uncertainties.

Pain intensity was assessed using the Visual Analogue Scale(VAS), 0-10, recorded at baseline and at each follow-up visit by the treating radiation oncologist. Analgesic consumption was quantified by converting all analgesics to oral morphine equivalent daily dose (OMEDD) using standard equianalgesic conversion tables, recorded by the same evaluator at baseline, day 3, and month 1.

Treatment response was classified according to the International Consensus Endpoints for palliative bone metastases radiotherapy trials (Chow et al., 2012, International Journal of Radiation Oncology, Biology, Physics). Complete response was defined as a pain score of 0 at the treated site with no increase in analgesic intake; partial response as a pain score reduction of ≥2 points without an increase in analgesic intake, or a reduction in OMEDD of ≥25% without an increase in pain score; progression as an increase in pain score of ≥2 points with a stable or increased OMEDD, or a ≥25% increase in OMEDD with a stable or increased pain score; and indeterminate response as any case not meeting the above criteria, including missing data. Analgesic doses were converted to oral morphine equivalents (OMEDD) prior to applying these criteria.

The median age at diagnosis of cancer in our study is globally lower 57.5 years. It’s globally the same like a others study in Africa in Ibadan Nigeria 45 years and Dakar 53 years Senegal [16][17] but remains lower than that reported in European populations [5]. This difference reflects the younger age structure of the Africa population and delayed diagnosis may contribute to earlier presentation with advanced disease.

The sex ratio observed in metastatic cancer cohorts is closely related to the distribution of primary tumor types. Male predominance is commonly reported in series with a high prevalence of prostate cancer, while female predominance is more frequently observed in cohorts where breast and gynecological malignancies are major contributors to metastatic disease.

Our study showed no more differences between male and female. In high income countries the sex ratio tends to be balanced due to significant contribution of breast cancer in women and lung cancer in both sexes [18]-[21].

In Our study, the three main primary tumors leading to bone metastases were Prostate 10 (41.67%) Lung 8 (33.33%) Breast 6 (25%). Similar distributions have been reported in African series [22]-[24]. In a large retrospective analysis of the National Cancer Database (NCDB), encompassing 50,929 patients received palliative radiotherapy for osseous metastases. The most frequently represented primary tumor was non-small cell lung cancer (NSCLC), accounting for 45.2% of cases, followed by breast cancer (15.1%) and prostate cancer (10.8%) among patients treated with palliative bone radiotherapy [25].

The difference in ranking between African studies, where prostate cancer predominates, and the American NCDB study, where lung cancer is leading, may be explained by the late stage of presentation and underdiagnosis of lung cancer in African settings.

In our study, CT scan was the most frequently used imaging modality for the detection of bone metastases, followed by MRI and bone scintigraphy. His finding is consistent with several international reports showing that CT remains one of the most commonly used imaging techniques in routine oncologic practice because it is widely available, fast, and frequently performed as part of staging or restaging examinations [26]-[28] although MRI and PET imaging have higher sensitivity for early marrow involvement [29]-[31].

In the African setting, the predominance of CT may also be explained by the limited availability of advanced imaging modalities such as MRI and PET, due to high costs, shortage of equipment, and unequal distribution of radiologic resources in Sub-Saharan Africa [32][33].

In our study, overall response was observed in 66.66% of patients at 72 hours and increased to 83.33% at one month after radiotherapy.

In this large prospective realworld cohort study of patients with painful bone metastases treated with external beam radiotherapy (EBRT), approximately 70 % (n = 1442/2067) of patients experienced a partial or complete pain response between 2 and 12 weeks after treatment, according to internationally accepted response criteria. The median time to pain response was 4 weeks [34].

A recent Ethiopian prospective study reported overall response rates of 65%, 67%, and 78% at 2, 4, and 8 weeks respectively [35]. The higher responses rate observed in our study may be related to the small size.

Interestingly, the proportion of undetermined responses decreased from 25.0% at Day 3 to 16.7% at Month 1. This difference reflects the acute post-treatment phase, where rapid analgesic titrations and the lack of structured outpatient visits at 72 hours generated missing data, whereas the 1-month evaluation benefited from formal clinical consultation.

Our study is primarily limited by its retrospective, single-center design and small sample size, which naturally come with risks of selection bias and incomplete medical records. Additionally, separating the precise effect of radiotherapy from adjustments in oral pain medication was difficult. Nevertheless, these limitations reflect the true landscape of everyday palliative care, where radiation therapy is never an isolated intervention but part of a collaborative, urgent effort to ease patient suffering.