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Imano N, Kosugi T, Konishi K, Saito T. Pain response in single-fraction 8-Gy radiotherapy for painful non-bone-metastasis tumors: a single-center retrospective study. JOURNAL OF RADIATION RESEARCH 2024; 65:408-412. [PMID: 38718386 PMCID: PMC11115466 DOI: 10.1093/jrr/rrae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/23/2024] [Indexed: 05/25/2024]
Abstract
The effectiveness of single-fraction 8-Gy radiotherapy for painful bone metastases has been verified in numerous randomized controlled trials. However, few reports have described the effectiveness of single-fraction 8-Gy radiotherapy in painful tumors other than bone metastases. We conducted a retrospective analysis to evaluate the pain response to single-fraction 8-Gy radiotherapy in painful non-bone-metastasis tumors. We included patients who had received single-fraction 8-Gy radiotherapy for such tumors between January 2017 and December 2022, excluding those with brain metastases, hematological tumors and those who received re-irradiation. Pain response assessment was based on the best responses documented in the medical records and conducted by two radiation oncologists. A total of 36 eligible patients were included in this study. The irradiation sites included primary lesions in eight patients, lymph node metastases in eight, muscle metastases in seven, pleural dissemination in four, skin/subcutaneous metastases in four and other sites in five. Pain response was assessed in 24 patients after radiotherapy. Pain response rate was 88% in evaluable patients; 21 of the 24 patients experienced response. The median assessment date for pain response was 37 days (range: 8-156 days) after radiotherapy. Re-irradiation was performed in four patients (11%). Single-fraction 8-Gy radiotherapy seemed to be a promising treatment option for painful non-bone-metastasis tumors and warrants further investigation.
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Affiliation(s)
- Nobuki Imano
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi, Hiroshima 734-8551, Japan
| | - Takashi Kosugi
- Department of Radiation Oncology, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda-shi, Shizuoka 426-8677, Japan
| | - Kenta Konishi
- Department of Radiation Oncology, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda-shi, Shizuoka 426-8677, Japan
- Department of Radiation Oncology, Hamamatsu University School of Medicine, 1-20-1, Handayama, Chuo-ku, Hamamatsu-shi, Shizuoka 431-3192, Japan
| | - Tetsuo Saito
- Department of Radiation Oncology, Ariake Medical Center, 2600, Arao, Arao-shi, Kumamoto 864-0041, Japan
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Donati CM, Maggiore CM, Maltoni M, Rossi R, Nardi E, Zamagni A, Siepe G, Mammini F, Cellini F, Di Rito A, Portaluri M, De Tommaso C, Santacaterina A, Tamburella C, Di Franco R, Parisi S, Cossa S, Fusco V, Bianculli A, Ziccarelli P, Ziccarelli L, Genovesi D, Caravatta L, Deodato F, Macchia G, Fiorica F, Napoli G, Buwenge M, Morganti AG. Adequacy of Pain Management in Patients Referred for Radiation Therapy: A Subanalysis of the Multicenter ARISE-1 Study. Cancers (Basel) 2023; 16:109. [PMID: 38201537 PMCID: PMC10778440 DOI: 10.3390/cancers16010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Pain is a prevalent symptom among cancer patients, and its management is crucial for improving their quality of life. However, pain management in cancer patients referred to radiotherapy (RT) departments is often inadequate, and limited research has been conducted on this specific population. This study aimed to assess the adequacy and effectiveness of pain management when patients are referred for RT. Moreover, we explored potential predictors of adequate pain management. METHODS This observational, prospective, multicenter cohort study included cancer patients aged 18 years or older who were referred to RT departments. A pain management assessment was conducted using the Pain Management Index (PMI), calculated by subtracting the pain score from the analgesic score (PMI < 0 indicated inadequate pain management). Univariate and multivariate analyses were performed to identify predictors of adequate pain management. RESULTS A total of 1042 cancer outpatients were included in the study. The analysis revealed that 42.9% of patients with pain did not receive adequate pain management based on PMI values. Among patients with pain or taking analgesics and referred to palliative or curative RT, 72% and 75% had inadequate or ineffective analgesic therapy, respectively. The odds of receiving adequate pain management (PMI ≥ 0) were higher in patients undergoing palliative RT (OR 2.52; p < 0.001), with worse ECOG-PS scores of 2, 3 and 4 (OR 1.63, 2.23, 5.31, respectively; p: 0.017, 0.002, 0.009, respectively) compared to a score of 1 for those with cancer-related pain (OR 0.38; p < 0.001), and treated in northern Italy compared to central and southern of Italy (OR 0.25, 0.42, respectively; p < 0.001). CONCLUSIONS In this study, a substantial proportion of cancer patients referred to RT departments did not receive adequate pain management. Educational and organizational strategies are necessary to address the inadequate pain management observed in this population. Moreover, increasing the attention paid to non-cancer pain and an earlier referral of patients for palliative RT in the course of the disease may improve pain response and treatment outcomes.
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Affiliation(s)
- Costanza M. Donati
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.S.); (F.M.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Chiara Maria Maggiore
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Marco Maltoni
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Romina Rossi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
- Palliative Care Unit, AUSL Romagna, 40121 Forlì, Italy
| | - Elena Nardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy
| | - Alice Zamagni
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Giambattista Siepe
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.S.); (F.M.); (A.G.M.)
| | - Filippo Mammini
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.S.); (F.M.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Francesco Cellini
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, IRCCS, UOC di Radioterapia, Fondazione Policlinico Universitario A. Gemelli, 00168 Roma, Italy;
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Alessia Di Rito
- IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
| | | | | | - Anna Santacaterina
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Consuelo Tamburella
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Rossella Di Franco
- S.C. di Radioterapia dell’Istituto Nazionale Tumori Pascale, 80131 Napoli, Italy;
| | - Salvatore Parisi
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Sabrina Cossa
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Vincenzo Fusco
- IRCCS CROB, 85028 Rionero in Vulture, Italy; (V.F.); (A.B.)
| | | | - Pierpaolo Ziccarelli
- U.O. Radioterapia Oncologica, S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Luigi Ziccarelli
- U.O. Radioterapia Oncologica, S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Domenico Genovesi
- Radiation Oncology Unit, Università degli Studi G. D’Annunzio, 66100 Chieti, Italy; (D.G.); (L.C.)
| | - Luciana Caravatta
- Radiation Oncology Unit, Università degli Studi G. D’Annunzio, 66100 Chieti, Italy; (D.G.); (L.C.)
| | - Francesco Deodato
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, 86100 Campobasso, Italy; (F.D.); (G.M.)
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, 86100 Campobasso, Italy; (F.D.); (G.M.)
| | - Francesco Fiorica
- U.O.C. di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Giuseppe Napoli
- U.O.C. di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Milly Buwenge
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Alessio G. Morganti
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.S.); (F.M.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
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Saito T, Murotani K, Ito K, Nakamura N, Oya N. Bias due to statistical handling of death and reirradiation in the assessment of duration of response after palliative radiotherapy: a scoping review and analysis of clinical data. Br J Radiol 2023; 96:20220398. [PMID: 36125225 PMCID: PMC10997018 DOI: 10.1259/bjr.20220398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We investigated the influence of handling death and reirradiation on the estimation of duration of response (DOR). METHODS First, we performed a scoping review on methods to assess DOR in palliative radiotherapy. Second, we performed three different analyses on a subgroup of patients from a previously published prospective study. The first analysis was a competing risks analysis considering relapse of pain as the event of interest and death and reirradiation as competing events (Analysis A). The second and third analyses were standard survival analyses where the event of interest was a composite outcome of relapse of pain, death, or reirradiation (Analysis B) and relapse of pain (Analysis C), respectively. RESULTS Death was considered as an event of interest in less than half of the papers, while reirradiation was not considered in any of the studies. Competing risks analysis was not performed in any of the studies. In the analysis of clinical data, competing risks analysis showed that relapse of pain predominated as the cause of the end of response. Median DOR was correctly estimated to be 4.1 months in Analyses A and B, but was overestimated to be 8.1 months in Analysis C. CONCLUSIONS Death and reirradiation should be treated as the events of interest that mark the end of response (as in Analyses A and B) to avoid overestimation of treatment efficacy and an invalid assumption of independent censoring. ADVANCES IN KNOWLEDGE The definition of end of response remains inconclusive in the assessment of DOR. We recommend competing risks analysis (Analysis A), by which we can estimate cumulative incidence of each event type and evaluate the necessity of reirradiation.
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Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Arao Municipal
Hospital, Arao, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume
University, Fukuoka, Japan
| | - Kei Ito
- Division of Radiation Oncology, Department of Radiology, Tokyo
Metropolitan Cancer and Infectious Diseases Center Komagome
Hospital, Tokyo, Japan
| | - Naoki Nakamura
- Department of Radiation Oncology, St. Marianna University
School of Medicine, Kanagawa, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University
Hospital, Kumamoto, Japan
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Donati CM, Macchia G, Siepe G, Zamagni A, Benini A, Cellini F, Buwenge M, Cilla S, Cammelli S, Rizzo S, Caravatta L, Wondemagegnhu T, Uddin AFMK, Deressa BT, Sumon MA, Lodi Rizzini E, Bazzocchi A, Morganti AG, Deodato F, Farina E. Short course palliative radiotherapy in advanced solid tumors: a pooled analysis (the SHARON project). Sci Rep 2022; 12:20978. [PMID: 36471159 PMCID: PMC9723107 DOI: 10.1038/s41598-022-25602-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Previous trials showed the tolerability and efficacy of a palliative radiotherapy (RT) regimen (SHARON) based on the 4 fractions delivered in 2 days in different oncological settings. In order to identify possible predictors of symptomatic response, the purpose of this study is to perform a pooled analysis of previous trials. We analyzed the impact on symptomatic response of the following parameters: tumor site, histological type, performance status (ECOG), dominant symptom, and RT dose using the Chi-square test and Fisher's exact test. One-hundred-eighty patients were analyzed. Median RT dose was 20 Gy (range: 14-20 Gy). The overall response rate was 88.8% (95% CI 83.3-92.7%) while pre- and post-treatment mean VAS was 5.3 (± 7.7) and 2.2 (± 2.2), respectively (p < 0.001). The overall response rate of pain, dyspnea, bleeding, dysphagia, and other symptoms was 86.2%, 90.9%, 100%, 87.5%, and 100%, respectively. Comparing the symptomatic effect based on the analyzed parameters no significant differences were recorded. However, patients with locally advanced disease showed a higher rate of symptomatic responses than metastatic ones (97.3% vs 83.0%; p = 0.021). Finally, the complete pain response rate was more than double in patients with mild to moderate (VAS: 4-7) compared to those with severe (VAS > 7) pain (36.0% vs 14.3%; p = 0.028). This pooled analysis showed high efficacy of the SHARON regimen in the relief of several cancer-related symptoms. The markedly and significantly higher complete pain response rate, in patients with mild-moderate pain, suggests early referral to palliative RT for patients with cancer-related pain.
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Affiliation(s)
- Costanza Maria Donati
- grid.6292.f0000 0004 1757 1758Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy ,grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Gabriella Macchia
- grid.8142.f0000 0001 0941 3192Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.8142.f0000 0001 0941 3192Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Giambattista Siepe
- grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Alice Zamagni
- grid.6292.f0000 0004 1757 1758Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Anna Benini
- grid.6292.f0000 0004 1757 1758Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy ,grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesco Cellini
- grid.8142.f0000 0001 0941 3192Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.8142.f0000 0001 0941 3192Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy ,grid.8142.f0000 0001 0941 3192Istituto di Radiologia, Università Cattolica Sacro Cuore, Rome, Italy
| | - Milly Buwenge
- grid.6292.f0000 0004 1757 1758Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Savino Cilla
- grid.8142.f0000 0001 0941 3192Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Silvia Cammelli
- grid.6292.f0000 0004 1757 1758Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy ,grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Stefania Rizzo
- grid.469433.f0000 0004 0514 7845Service of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Luciana Caravatta
- grid.412451.70000 0001 2181 4941Department of Radiation Oncology, Santissima Annunziata Hospital, Gabriele D’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Tigeneh Wondemagegnhu
- grid.59547.3a0000 0000 8539 4635Radiotherapy Department, Tikur Anbessa Specialized Hospital, Department of Clinical Oncology, College of Medicine and Health Sciences, University of Gondar, 9086 Addis Ababa, Ethiopia
| | | | - Biniyam Tefera Deressa
- grid.59547.3a0000 0000 8539 4635Radiotherapy Department, Tikur Anbessa Specialized Hospital, Department of Clinical Oncology, College of Medicine and Health Sciences, University of Gondar, 9086 Addis Ababa, Ethiopia
| | - Mostafa A. Sumon
- Department of Radiation Oncology, United Hospital Limited, Dhaka, Bangladesh
| | - Elisa Lodi Rizzini
- grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Alberto Bazzocchi
- grid.419038.70000 0001 2154 6641Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessio G. Morganti
- grid.6292.f0000 0004 1757 1758Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy ,grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesco Deodato
- grid.8142.f0000 0001 0941 3192Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.8142.f0000 0001 0941 3192Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Eleonora Farina
- grid.416315.4Radiotherapy Unit, Azienda Ospedaliero-Universitaria Di Ferrara, Ferrara, Italy
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Saito T, Nakamura N, Oya N. A neuropathic component of tumor-related pain as a predictor of good response to palliative radiotherapy. Radiother Oncol 2022; 175:17. [PMID: 35952975 DOI: 10.1016/j.radonc.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Arao Municipal Hospital, Kumamoto, Japan.
| | - Naoki Nakamura
- Department of Radiation Oncology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
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Yamaguchi K, Saito T, Toya R, Tomitaka E, Matsuyama T, Fukugawa Y, Watakabe T, Otsuka H, Oya N. Palliative radiotherapy for painful lymph node metastases. Radiat Oncol 2021; 16:178. [PMID: 34530897 PMCID: PMC8447670 DOI: 10.1186/s13014-021-01900-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence concerning radiotherapy for painful lymph node metastases (PLM). We evaluated the effectiveness of radiotherapy for PLM using the International Consensus Endpoint in a subgroup analysis of a prospective observational study. METHODS In the primary study, 302 patients received radiotherapy for painful tumors. Among them, those treated with palliative radiotherapy for PLM were analyzed in the present study. We used the Brief Pain Inventory short form to evaluate the intensity of pain and the pain interference in patient's life. We collected the Brief Pain Inventory and analgesic data at baseline and at 1, 2, and 3 months after the start of radiotherapy. Pain response was assessed using the International Consensus Endpoint. Patients were diagnosed with a predominance of other pain (POP) if non-index pain of a malignant or unknown origin was present and had a greater 'worst pain' score than the index pain. RESULTS Radiotherapy for PLM was performed on 25 patients. In total, 15 (60%) patients experienced a pain response. The pain response rates for evaluable patients were 66%, 67%, and 57% at 1-, 2-, and 3-month follow-ups, respectively. At baseline and at 1, 2, and 3 months, the median index pain scores were 7, 2, 0, and 0.5, respectively. At 1 month, all pain interference scores were significantly reduced from baseline. Four (16%) patients experienced POP within three months. CONCLUSION Radiotherapy for PLM improved pain intensity and pain interference. Palliative radiotherapy may be a viable treatment option for PLM.
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Affiliation(s)
- Kohsei Yamaguchi
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. .,Department of Radiation Oncology, Arao Municipal Hospital, Arao, Japan. .,Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan.
| | - Tetsuo Saito
- Department of Radiation Oncology, Arao Municipal Hospital, Arao, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.,Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi, Japan
| | - Etsushi Tomitaka
- Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yoshiyuki Fukugawa
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.,Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi, Japan
| | - Takahiro Watakabe
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.,Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi, Japan
| | - Hirohito Otsuka
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.,Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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7
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Saito T, Murotani K, Yamaguchi K, Toya R, Tomitaka E, Watakabe T, Oya N. Influence of pain duration on pain outcomes following palliative radiotherapy for painful tumors: the sooner the irradiation, the better? Strahlenther Onkol 2021; 197:916-925. [PMID: 33783573 DOI: 10.1007/s00066-021-01760-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The influence of pre-radiotherapy pain duration on post-treatment outcomes was assessed. METHODS Patients that received palliative radiotherapy were analyzed in a prospective observational study investigating curative and palliative radiotherapy. Brief Pain Inventory data were acquired at baseline and 1, 2, and 3 months after commencing irradiation. The pain response in terms of the index pain (i.e., pain caused by the irradiated tumors) was assessed using the International Consensus Endpoint. Patients were diagnosed with predominance of other pain (POP) if non-index pain of malignant or unknown origin was present and showed a higher pain score than the index pain. Competing risk analyses were performed in which deaths without the pain endpoints were considered as competing events. RESULTS Of 229 patients analyzed, 123 (54%) experienced a pain response and 43 (19%) experienced POP. Multivariable analyses using the Fine-Gray model revealed that patients with shorter pain duration (< 1 month) had higher cumulative incidence of pain response (subdistribution hazard ratio, 2.43; 95% confidence interval [CI], 1.35-4.38) and POP (subdistribution hazard ratio, 4.22; 95% CI, 1.30-13.70) compared with patients with longer pain duration (≥ 4 months). For patients with a pain duration of less than 1 month, cumulative incidence of pain response was estimated to be 69% (95% CI, 53-85%) and cumulative incidence of POP was estimated to be 15% (95% CI, 3-28%) at 1‑month follow-up. CONCLUSION Commencing palliative radiotherapy earlier may improve the probability of patients achieving a pain response, although POP may be more frequent.
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Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Arao Municipal Hospital, Kumamoto, Japan. .,Graduate School of Medicine, Kurume University, Fukuoka, Japan.
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, Fukuoka, Japan
| | - Kohsei Yamaguchi
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Etsushi Tomitaka
- Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan
| | - Takahiro Watakabe
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan.,Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
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Saito T, Nakamura N, Murotani K, Shikama N, Takahashi T, Yorozu A, Heianna J, Kubota H, Tomitaka E, Toya R, Yamaguchi K, Oya N. Index and Nonindex Pain Endpoints in Radiation Therapy for Painful Tumors: A Secondary Analysis of a Prospective Observational Study. Adv Radiat Oncol 2020; 5:1118-1125. [PMID: 33305072 PMCID: PMC7718541 DOI: 10.1016/j.adro.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/02/2020] [Accepted: 09/22/2020] [Indexed: 01/01/2023] Open
Abstract
Purpose Improving pain interference in daily activities, rather than mere pain reduction, is a desirable endpoint for palliative radiation therapy. The association between pain response and pain interference has been studied almost exclusively in patients with painful bone metastases (PBMs), whereas nonindex pain has scarcely been explored in palliative radiation therapy. We investigated whether index and nonindex pain endpoints are associated with pain interference changes in patients with both PBMs and painful non-bone-metastasis tumors (PNTs). Methods and Materials Brief pain inventory data collected at baseline and at 2 months post-treatment were used to calculate differences in pain interference scores. Pain response in terms of the index pain was assessed using the international consensus endpoint. Patients were diagnosed with predominance of other pain (POP) if nonindex pain of malignant or unknown origin was present and had a greater pain score than the index pain. Results Of 302 patients, 127 (42%) had PBMs and 175 (58%) had PNTs. The median pain interference score, which is based on the mean of the 7 subscale items, decreased to a greater extent among responders than among nonresponders (PBM group: –3.43 vs –0.57 [P = .005]; PNT group: –2.43 vs –0.29 [P < .001]). Moreover, patients without POP experienced a greater reduction in their median pain interference score than did those with POP (PBM group: –2.71 vs +0.43 [P = .004]; PNT group: –2.00 vs +1.57 [P = .007]). The Jonckheere-Terpstra test showed a significant trend across 4 pain response categories in patients with PBMs and those with PNTs (P < .001 for both). Conclusions The index and nonindex pain endpoints were positively and negatively associated with improvement in pain interference, respectively. There was no apparent difference between patients with PBMs and PNTs in terms of the associations of these endpoints with pain interference.
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Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
- Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi, Japan
- Graduate School of Medicine, Kurume University, Fukuoka, Japan
- Corresponding author: Tetsuo Saito, MD, PhD
| | - Naoki Nakamura
- Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, Fukuoka, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Takeo Takahashi
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Atsunori Yorozu
- Department of Radiation Oncology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Joichi Heianna
- Department of Radiology, Graduate School of Medical Science University of The Ryukyus, Okinawa, Japan
| | - Hikaru Kubota
- Department of Radiation Oncology, Kobe University Hospital, Hyogo, Japan
| | - Etsushi Tomitaka
- Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Kohsei Yamaguchi
- Department of Radiology, Amakusa Central Hospital, Amakusa, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
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Saito T, Shikama N, Yorozu A, Kubota H, Murotani K, Yamaguchi K, Oya N, Nakamura N. Inconsistencies in assessment of pain endpoints in radiotherapy for painful tumors: Analysis of original articles in the Green and Red Journals. Clin Transl Radiat Oncol 2020; 24:111-115. [PMID: 32760815 PMCID: PMC7393456 DOI: 10.1016/j.ctro.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 11/05/2022] Open
Abstract
The frequency of use of the ICT has risen in research for PBMs. The frequency of the ICT use has been considerably limited for PNTs. None of the journal articles had investigated non-index pain.
Background and purpose Consistent assessment of the pain response is essential for adequately comparing treatment efficacy between studies. We studied the assessment of pain endpoints in radiotherapy for painful bone metastases (PBMs) and painful non-bone-metastasis tumors (PNTs). Material and methods We performed a literature search in the Green (Radiotherapy and Oncology) and Red (International Journal of Radiation Oncology * Biology * Physics) Journals for full-length original articles published between 2009 and 2018. We only included articles that assessed palliation of tumor-related pain after radiotherapy. The data obtained included the definitions of pain response and assessment of non-index pain (pain other than that related to the irradiated tumors). Results Among the 1812 articles identified using the journals’ search function, 60 were included in the analysis. Thirty percent of the PBM articles and approximately half of the PNT articles did not report on analgesic use. Among the prospective studies, 68% of the articles on PBMs and 10% of the articles on PNTs used the International Consensus Endpoint. The PBM articles published in 2014–2018 utilized the International Consensus Endpoint more frequently than those published in 2009–2013 (p = 0.049). No articles reported information on non-index pain. Conclusions After the initial publication of the International Consensus Endpoint, the frequency of its use appears to have risen in PBM research; however, its use in PNT studies has been considerably limited. The International Consensus Endpoint should be consistently utilized in future studies on radiotherapy for painful tumors. Since none of the journal articles had investigated non-index pain, this issue may also needs to be addressed.
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Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan.,Graduate School of Medicine, Kurume University, Fukuoka, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Atsunori Yorozu
- Department of Radiation Oncology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hikaru Kubota
- Department of Radiation Oncology, Kobe University Hospital, Hyogo, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, Fukuoka, Japan
| | - Kohsei Yamaguchi
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Naoki Nakamura
- Department of Radiology, St. Marianna University Hospital, Kawasaki, Japan
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Saito T, Tomitaka E, Toya R, Oya N. Possible Dose–Response Relationship in Palliative Radiotherapy for Non-bone Painful Lesions. Clin Oncol (R Coll Radiol) 2019; 31:391-398. [DOI: 10.1016/j.clon.2019.03.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/01/2018] [Accepted: 02/25/2019] [Indexed: 11/24/2022]
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Saito T, Toya R, Tomitaka E, Matsuyama T, Ninomura S, Watakabe T, Oya N. Improvement in pain interference after palliative radiotherapy for solid and hematologic painful tumors: a secondary analysis of a prospective observational study. Jpn J Clin Oncol 2018; 48:982-987. [PMID: 30239863 DOI: 10.1093/jjco/hyy130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/31/2018] [Indexed: 11/14/2022] Open
Abstract
Background We previously demonstrated that patients with painful hematologic tumors were more likely to experience pain response after palliative radiotherapy (RT) than those with painful solid tumors. However, it is unknown whether change in pain interference differs between these two tumor types. In the present study, we carried out a secondary analysis of our previous prospective observational study to investigate this matter. Methods From patients undergoing palliative RT to treat painful tumors, Brief Pain Inventory data were collected at the start of RT and at the 1-, 2-, and 3- month follow-ups. The Mann-Whitney U test was used to compare changes in pain interference score from baseline between the two groups. Results Of the 237 patients, 203 (86%) had solid and 34 (14%) had hematologic index tumors planned to receive RT. At baseline, the groups did not differ significantly in terms of pain score, analgesic use, or pain interference score. At the 1-, 2-, and 3-month follow-ups, the changes in pain interference score from baseline did not differ significantly between the two groups. In both groups, all seven pain interference items, other than sleep in patients with hematologic tumors at the 2-month follow-up, were significantly improved (P < 0.05). Conclusions The two groups showed comparable benefit from RT in terms of improvement in pain interference. Patients with tumor-related pain should be offered the option of palliative RT, irrespective of whether the painful tumor is solid or hematologic.
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Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto.,Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto
| | - Etsushi Tomitaka
- Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto
| | - Satoshi Ninomura
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto
| | - Takahiro Watakabe
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto
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Saito T, Toya R, Tomitaka E, Matsuyama T, Ninomura S, Watakabe T, Oya N. Predictors of the Predominance of NonIndex Pain After Palliative Radiation Therapy for Painful Tumors. Adv Radiat Oncol 2018; 4:118-126. [PMID: 30706019 PMCID: PMC6349584 DOI: 10.1016/j.adro.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose Even when index pain (pain caused by the irradiated tumor) is palliated after radiation therapy (RT), patients may not derive the full benefits of RT in the presence of another, more intense pain. In this case-control study with prospectively collected data, we sought to identify predictors of the predominance of nonindex pain after palliative RT. Methods and Materials Brief Pain Inventory data were collected from patients who received RT for painful tumors. The treating radiation oncologists prospectively evaluated the intensity and origin of nonindex pain. Patients were diagnosed with predominance of other pain (POP) if nonindex pain of malignant or unknown origin was present and had a greater worst pain score than the index pain at the 1- or 2-month follow-up. Changes in pain interference from baseline to follow-up were compared between the 2 groups using Mann-Whitney U tests. Using variables that were identified as significant in a multivariable logistic regression analysis, we developed a prediction model for POP. Results Of the 170 patients who were evaluable at the 2-month follow-up, 24 (14%) were diagnosed with POP. At the 2-month follow-up examination of the patients with POP, none of the items of the pain interference scores were reduced from baseline; in contrast, patients without POP experienced significant reductions in all items. Multivariable analysis using the backward elimination method indicated that age ≤65 years, the presence of nonindex pain of malignant or unknown origin at baseline, and no opioid analgesic use at baseline were significant independent predictors of POP. As the number of the risk factors increased, the proportion of patients with POP increased. Conclusions We identified three predictors of POP. For patients likely to have POP, careful follow-up is important, and new palliative RT or analgesics should be used when needed.
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Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan.,Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Etsushi Tomitaka
- Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Satoshi Ninomura
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Takahiro Watakabe
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
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13
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Saito T, Tomitaka E, Toya R, Matsuyama T, Ninomura S, Watakabe T, Oya N. A neuropathic pain component as a predictor of improvement in pain interference after radiotherapy for painful tumors: A secondary analysis of a prospective observational study. Clin Transl Radiat Oncol 2018; 12:34-39. [PMID: 30148216 PMCID: PMC6105926 DOI: 10.1016/j.ctro.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/09/2018] [Indexed: 01/22/2023] Open
Abstract
A neuropathic component was related to worse pain interference scores at baseline. A neuropathic component predicted a greater reduction in pain interference. Older patients and male patients tended to have a neuropathic component.
Background and purpose We previously demonstrated that patients with a tumor-related neuropathic pain component were more likely to experience a pain response after radiotherapy (RT) than those without. It is unknown whether the presence of a neuropathic component also favorably influences pain interference. In a secondary analysis of our previous prospective observational study, we investigated if the presence of a neuropathic component of the index pain caused by the irradiated tumors predicts greater reduction in pain interference. Material and methods For patients scheduled for RT for painful tumors, Brief Pain Inventory data were collected at initiation of RT and 1, 2, and 3 months thereafter. Multivariable linear regression analyses were performed to investigate the effects of the presence of a neuropathic component on the changes in pain interference scores (i.e., follow-up minus baseline). We used 10 covariates as potential confounders. Results Of the 302 analyzable patients, 93 (31%) were diagnosed as having a neuropathic component of the index pain. Multivariable linear regression analyses revealed that all the point estimates of regression coefficients at 1-, 2-, and 3-month follow-up were negative values; some were statistically significant. At 2-month follow-up, patients with a neuropathic component experienced greater reductions in their pain interference scores for walking ability (p = 0.048), normal work (p = 0.021), sleep (p = 0.001), and enjoyment of life (p = 0.010) than those without it. Conclusions The presence of a neuropathic pain component predicted a greater reduction in pain interference after RT. Patients with neuropathic tumor-related pain should be offered the option of receiving palliative RT.
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Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
- Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi, Japan
- Corresponding author at: Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto-shi, Kumamoto 860-8556, Japan.
| | - Etsushi Tomitaka
- Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Satoshi Ninomura
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Takahiro Watakabe
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
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