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Berk L, Scarantino C, Finkelstein S, Finkelstein M. Hemibody Irradiation for Bone Metastases: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e51925. [PMID: 38333455 PMCID: PMC10851327 DOI: 10.7759/cureus.51925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Hemibody irradiation (HBI) is a radiation therapy technique that involves treating one-half of the patient's skeletal system in a single radiation field. It is mostly given as upper hemibody irradiation (UHBI), lower hemibody irradiation (LHBI), or sequential UHBI and LHBI. It is used to treat extensive bone metastases from solid tumors. It was primarily utilized in the 1980s and 1990s and has since fallen out of favor. However, it is a potentially cost-effective treatment for widespread bone metastases. To determine its efficacy, we performed a meta-analysis of all available published articles on the efficacy of HBI to relieve pain from bone metastases. Twenty-seven articles involving 1318 patients were identified and analyzed. Our findings show that 80% of the patients had complete or partial pain relief and 29% had complete pain relief. The trials were of poor quality, but the results showed minimal heterogeneity in the response rates. These response rates are consistent with those seen with focal irradiation of bone metastases and for radionuclide treatment of bone metastases. The toxicity of the treatments decreased when delivered with modern treatment techniques. In light of this, we propose that this technique warrants re-evaluation with modern treatment methods.
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Affiliation(s)
- Lawrence Berk
- Radiation Oncology, Tampa Oncology and Proton, Winter Haven, USA
| | | | | | - Mitchell Finkelstein
- Radiation Oncology, Barrett, The Honors College at Arizona State University, Tempe, USA
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Palliative Efficacy of High-Dose Stereotactic Body Radiotherapy Versus Conventional Radiotherapy for Painful Non-Spine Bone Metastases: A Propensity Score-Matched Analysis. Cancers (Basel) 2022; 14:cancers14164014. [PMID: 36011008 PMCID: PMC9406761 DOI: 10.3390/cancers14164014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: The superiority of stereotactic body radiotherapy (SBRT) over conventional external beam radiotherapy (cEBRT) in terms of pain palliation for bone metastases remains controversial. (2) Methods: This propensity score-matched study compared the overall pain response (OR) 3 months after radiotherapy among patients with painful (≥2 points on a 0-to-10 scale) non-spine bone metastases. Patients with lesions that were treated with SBRT or cEBRT and whose pain scores were evaluated 3 months after radiotherapy were included in this study. Pain response was evaluated according to the International Consensus Criteria. (3) Results: A total of 234 lesions (SBRT, n = 129; cEBRT, n = 105) were identified in our institutional database. To reduce the confounding effects, 162 patients were selected using a propensity score-matched analysis (n = 81 for each treatment). The OR rate at 3 months after SBRT was significantly higher than that after cEBRT (76.5% vs. 56.8%; p = 0.012). A noteworthy finding of our study is that the same trend was observed even after 6 months (75.9% vs. 50.0%; p = 0.011). The 1-year local failure rates after SBRT and cEBRT were 10.2% and 33.3% (p < 0.001), respectively. (4) Conclusions: Our findings suggest that SBRT is superior to cEBRT for pain palliation in patients with non-spine bone metastases.
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van der Velden J, Willmann J, Spałek M, Oldenburger E, Brown S, Kazmierska J, Andratschke N, Menten J, van der Linden Y, Hoskin P. ESTRO ACROP guidelines for external beam radiotherapy of patients with uncomplicated bone metastases. Radiother Oncol 2022; 173:197-206. [PMID: 35661676 DOI: 10.1016/j.radonc.2022.05.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/16/2022] [Accepted: 05/26/2022] [Indexed: 12/20/2022]
Abstract
After liver and lungs, bone is the third most common metastatic site (Nystrom et al., 1977). Almost all malignancies can metastasize to the skeleton but 80% of bone metastases originate from breast, prostate, lung, kidney and thyroid cancer (Mundy, 2002). Introduction of effective systemic treatment in many cancers has prolonged patients' survival, including those with bone metastases. Bone metastases may significantly reduce quality of life due to related symptoms and possible complications, such as pain and neurologic compromise. The most serious complications of bone metastases are skeletal-related events (SRE), defined as pathologic fracture, spinal cord compression, pain, or other symptoms requiring an urgent intervention such as surgery or radiotherapy. In turn, growing access to modern diagnostic tools allows early detection of asymptomatic bone metastases that could be successfully managed with local treatment avoiding development of SRE. The treatment for bone metastases should focus on relieving existing symptoms and preventing new ones. Radiotherapy is the standard of care for patients with symptomatic bone metastases, providing durable pain relief with minimal toxicity and reasonable cost-effectiveness. Historically, the dose was prescribed in one to five fractions and delivered using simple planning techniques. While 3D-conformal radiotherapy is still widely used for treating bone metastases, introduction of highlyconformal radiotherapy techniques such as stereotactic body radiotherapy (SBRT) have opened new therapeutic possibilities that should be considered in selected patients with bone metastases.
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Affiliation(s)
- Joanne van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht 3584 CX, Netherlands
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Mateusz Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospital Leuven, Herestraat 49, B3000 Leuven, Belgium
| | - Stephanie Brown
- Mount Vernon Cancer Centre, Northwood, UK and University of Manchester, United Kingdom
| | - Joanna Kazmierska
- Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland; Electroradiology Department, University of Medical Sciences, Poznan, Poland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Johan Menten
- Department of Radiation Oncology, University Hospital Leuven, Herestraat 49, B3000 Leuven, Belgium; Catholic University Leuven, B3000 Leuven, Belgium
| | - Yvette van der Linden
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht 3584 CX, Netherlands
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, UK and University of Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, United Kingdom
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Bauman GS, Corkum MT, Fakir H, Nguyen TK, Palma DA. Ablative radiation therapy to restrain everything safely treatable (ARREST): study protocol for a phase I trial treating polymetastatic cancer with stereotactic radiotherapy. BMC Cancer 2021; 21:405. [PMID: 33853550 PMCID: PMC8048078 DOI: 10.1186/s12885-021-08020-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/10/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients with polymetastatic cancer are most often treated with systemic therapy to improve overall survival and/or delay progression, with palliative radiotherapy reserved for sites of symptomatic disease. Stereotactic ablative radiotherapy (SABR) has shown promise in the treatment of oligometastatic disease, but the utility of SABR in treating all sites of polymetastatic disease has yet to be evaluated. This study aims to evaluate the maximally tolerated dose (MTD) of SABR in patients with polymetastatic disease. METHODS Up to 48 patients with polymetastatic cancer (> 10 sites) will be enrolled on this phase I, modified 3 + 3 design trial. Eligible patients will have exhausted (or refused) standard systemic therapy options. SABR will be delivered as an escalating number of weekly fractions of 6 Gy, starting at 6 Gy × 2 weekly fractions (dose level 1). The highest dose level (dose level 4) will be 6 Gy × 5 weekly fractions. Feasibility and safety of SABR will be evaluated 6 weeks following treatment using a composite endpoint of successfully completing treatment as well as toxicity outcomes. DISCUSSION This study will be the first to explore delivering SABR in patients with polymetastatic disease. SABR will be planned using the guiding principles of: strict adherence to dose constraints, minimization of treatment burden, and minimization of toxicity. As this represents a novel use of radiotherapy, our phase I study will allow for careful selection of the MTD for exploration in future studies. TRIAL REGISTRATION This trial was prospectively registered in ClinicalTrials.gov as NCT04530513 on August 28, 2020.
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Affiliation(s)
- Glenn S Bauman
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6C 1K1, Canada.
| | - Mark T Corkum
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6C 1K1, Canada
| | - Hatim Fakir
- Department of Medical Biophysics, London Health Sciences Centre, London, Ontario, Canada
| | - Timothy K Nguyen
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6C 1K1, Canada
| | - David A Palma
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6C 1K1, Canada
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Frantellizzi V, Monari F, Mascia M, Costa R, Rubini G, Spanu A, Farcomeni A, Lodi Rizzini E, Cindolo L, Murabito A, Lavelli V, Nuvoli S, Cosma L, Dionisi V, Nappi AG, Andreola M, De Vincentis G. A National Multicenter Study on overall survival in elderly metastatic castrate-resistant prostate cancer patients treated with Radium-223. Aging Clin Exp Res 2021; 33:651-658. [PMID: 32358729 DOI: 10.1007/s40520-020-01573-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Radium-223 prolongs overall survival (OS) and delays time to the first symptomatic skeletal events in patients with symptomatic metastatic castration-resistant prostate cancer (mCRPC). There is a lack of evidence on the safety and efficacy of Radium-223 treatment in the very elderly population. AIMS Aim of this multicentre study is to analyze mCRPC patients treated with Radium-223 in terms of OS and to assess whether there are differences between young and elderly, as well as to verify efficacy and safety in patients ≥ 75 years of age. METHODS 430 mCRPC patients of six Italian Centres were analyzed in this multicenter retrospective study. At baseline and after each cycle were collected clinical and diagnostic patients' parameters. The whole cohort was divided into two groups based on the age of the patients (< 75 years old and ≥ 75 years old). RESULTS 47% of the patients were < 75 years old and 53% were ≥ 75 years old. The primary outcome, OS, does not show significant differences between the two subgroups if other basal parameters are considered. Considering clinical covariates in univariate models (p < 0.05) several clinical aspects have an impact on OS, except for age (p = 0.072). Age continues to have no significant impact on the OS (p = 0.274) even in multivariate models in the two groups. The toxic effects are similar in the two groups. CONCLUSIONS Radium-223 prolongs survival in both younger and older patients at the same baseline condition and is a good option in the symptomatic mCRPC setting compared to other agents.
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Oldenburger E, Oldenburger F, Coolbrandt A, Isebaert S, Neyens I, Sevenants A, Van Audenhove C, Haustermans K. The use of patient reported outcome measures (PROMs) in palliative radiotherapy: A topical review. Radiother Oncol 2020; 149:94-103. [DOI: 10.1016/j.radonc.2020.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 01/11/2023]
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Rastogi K, Gupta S, Bhaskar S, Bhatnagar AR, Bairwa SC, Jain S. Symptom Palliation in Patients with Bone Metastases Treated with Radiotherapy. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_200_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Context: Skeleton is the most common organ affected by metastases. Bone pain is the most common symptom of metastatic bone disease. The treatment of bone metastasis is primarily palliative requiring multidisciplinary therapies; radiotherapy (RT), however, remains the cornerstone of the treatment. Aims: The aim of this study is to measure the effectiveness of RT in terms of symptomatic relief in pain and insomnia, improvement in stability/movement, and decrease in the requirement of analgesics by patients using the Hundred Paisa Pain Scale. Subjects and Methods: The RT records of 226 patients with bone metastasis treated at the department of Radiotherapy, SMS Medical College, Jaipur; from July 2015 to December 2016 over cobalt-60 teletherapy unit were analyzed. The RT dose fractionation ranged from 30 Gy in 10 daily fractions, 20 Gy in 5 daily fractions, 12.5 Gy in 2 weekly fractions, and 8 Gy in single fraction. Results: The median age of the cohort was 54 (range, 29–84) years. The most common site of primary tumor was lung (30.1%), followed by breast (12.4%) and prostate (11.9%). The most common bone involved was vertebrae (71.2%), followed by pelvis (14.6%); among vertebrae, thoracic vertebrae were most commonly involved (63.9%), followed by lumbar vertebrae (57.8%). The maximum relief in pain was seen with 6.25 Gy/fraction schedule, whereas the maximum improvement in stability/movement was noted with 3 Gy/fraction schedule. The 8 Gy single-fraction schedule was associated with maximum relief in insomnia and decrease in analgesic requirement. Conclusion: The current institutional protocol of weekly hypofractionated palliative RT of 6.25 Gy per fraction up to a maximum of four fractions given on Saturday has shown results comparable with other schedules with well tolerance and achievement of acceptable symptom palliation. This weekly schedule is practically convenient to both the patients who mostly came from far-flung areas and the institute as it spares the already overburdened machine to carry on conventional RT from Monday to Friday.
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Affiliation(s)
- Kartick Rastogi
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
| | - Shivani Gupta
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
| | - Sandeep Bhaskar
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
| | | | - Subhash-Chand Bairwa
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
| | - Sandeep Jain
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
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Xu Q, Zhang S, Zhao Y, Feng Y, Liu L, Cai L, Zhang W, Huang Z, Wei H, Zhuo L, Chen Y. Radiolabeling, quality control, biodistribution, and imaging studies of 177
Lu-ibandronate. J Labelled Comp Radiopharm 2018; 62:43-51. [PMID: 30426535 DOI: 10.1002/jlcr.3694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/23/2018] [Accepted: 11/06/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Qin Xu
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Shumao Zhang
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Yan Zhao
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Yue Feng
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Lin Liu
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Liang Cai
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- State Key laboratory of Quality Research in Chinese Medicine/Macau Institute for Applied Research in Medicine and Health; Macau University of Science and Technology; Taipa Macau SAR PR China
| | - Wei Zhang
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Zhanwen Huang
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Hongyuan Wei
- Isotope Technology and Application Laboratory; Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics; Mianyang PR China
- Key Laboratory of Nuclear Medicine and Molecular Imaging of Sichuan Province; Mianyang China
| | - Liangang Zhuo
- Isotope Technology and Application Laboratory; Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics; Mianyang PR China
- Key Laboratory of Nuclear Medicine and Molecular Imaging of Sichuan Province; Mianyang China
| | - Yue Chen
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
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Macchia G, Ferro M, Cilla S, Buwenge M, Ianiro A, Boccardi M, Picardi V, Ferro M, Arena E, Zamagni A, Cammelli S, Valentini V, Morganti AG, Deodato F. Efficacy and safety of 3D-conformal half body irradiation in patients with multiple bone metastases. Clin Exp Metastasis 2018; 35:747-752. [PMID: 30251079 DOI: 10.1007/s10585-018-9939-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/20/2018] [Indexed: 11/28/2022]
Abstract
Half-body irradiation (HBI) represented a standard treatment for multiple painful bone metastases (BMs). However, its use has progressively reduced due to the associated toxicity rates. The aim of this paper was to evaluate HBI delivered by conformal radiotherapy (RT) technique in a large patients population with widespread BMs. HBI was delivered in 3 Gy fractions, bid, ≥ 6 h apart, on 2 consecutive days (total dose: 12 Gy) using 3-dimensional conformal RT (3D-CRT) box technique. The target included pelvic bones, lumbar-sacral vertebrae and upper third of femurs. Acute and late toxicity was scored based on RTOG and EORTC-RTOG scales, respectively. Pain was evaluated using the Pain-Drug scores and the Visual Analog Scale (VAS). One hundred and eighty patients were eligible for inclusion in this retrospective analysis. Grade 3 and 4 acute toxicity rates were 1.1% and 0.0%, respectively. Mean VAS before and after HBI was 5.3 versus 2.7, respectively (p: 0.0001). Based on VAS, 37.5% of patients showed complete pain relief (VAS: 0) while 38.1% had partial response (≥ 2-point VAS reduction). Overall, Pain and Drug Score reduction was observed in 76.3% and 50.4% of patients, respectively. 1-, 2-, and 3-year pain progression free survival was 77.0%, 63.4%, and 52.7%, respectively. Thirty patients (16.7%) underwent RT retreatment on the same site with median 15.9 months interval (range 2-126 months). HBI delivered with 3D-CRT technique is safe and effective. It provides long lasting pain control in patients with multiple BMs with negligible rates of relevant toxicity.
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Affiliation(s)
- Gabriella Macchia
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy
| | - Milena Ferro
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy.
| | - Savino Cilla
- Medical Physics Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Anna Ianiro
- Medical Physics Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| | - Mariangela Boccardi
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy
| | - Vincenzo Picardi
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy
| | - Marica Ferro
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy
| | - Eleonora Arena
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy
| | - Alice Zamagni
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vincenzo Valentini
- Radiotherapy Department, Policlinico Universitario "A. Gemelli", Catholic University of Sacred Heart, Rome, Italy
| | - Alessio G Morganti
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesco Deodato
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy
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Delinikolas P, Patatoukas G, Kouloulias V, Dilvoi M, Plousi A, Efstathopoulos E, Platoni K. A novel Hemi-Body Irradiation technique using electron beams (HBIe -). Phys Med 2018. [PMID: 29519403 DOI: 10.1016/j.ejmp.2017.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
PURPOSE Certain radiation responsive skin diseases may develop symptoms on the upper or the lower half of the body. The concept of a novel Hemi-Body Electron Irradiation (HBIe-) technique, described in this work, provides a low cost, LINAC based, intermediate treatment option in between extremely localized and Total Skin irradiation techniques. MATERIALS AND METHODS The HBIe- technique, developed in our department, incorporates a custom crafted treatment chamber equipped with adjustable Pb shielding and a single electron beam in extended Source-Skin Distance (SSD) setup. The patient is positioned in 'Stanford' technique positions. The geometrical setup provides both optimal dose homogeneity and dose deposition up to a depth of 2 cm. To confirm this, the following characteristics were measured and evaluated: a) percentage depth dose (PDD) on the treatment plane produced by a single electron beam at perpendicular incidence for six fields at 'Stanford' angles, b) 2D profile of the entrance dose on the treatment plane produced by a single field and c) the total surface dose on an anthropomorphic phantom delivered by all 6 fields. RESULTS The resulting homogeneity of the surface dose in the treatment plane for an average patient was 5-6%, while surface dose homogeneity on the anthropomorphic phantom was 7% for both the upper and the lower HBIe- variants. The total PDD exhibits an almost linear decrease to a practical range of 2 g/cm2. CONCLUSION In conclusion, HBIe- was proven effective in delivering the prescribed dose to the target area, while protecting the healthy skin.
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Affiliation(s)
- Panagiotis Delinikolas
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece; Space Radiobiology Research, Physics Department, Strathclyde University, Glasgow, UK.
| | - Georgios Patatoukas
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Vasilios Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Maria Dilvoi
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Agapi Plousi
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Efstathios Efstathopoulos
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Kalliopi Platoni
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
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11
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Rose JN, Crook JM. The role of radiation therapy in the treatment of metastatic castrate-resistant prostate cancer. Ther Adv Urol 2015; 7:135-45. [PMID: 26161144 DOI: 10.1177/1756287215576647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In the setting of castrate-resistant prostate cancer, patients present with a variety of symptoms, including bone metastases, spinal cord compression and advanced pelvic disease. Fortunately, a variety of radiotherapeutic options exist for palliation. This article focuses on these options, including both external beam radiotherapy and radiopharmaceuticals.
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Affiliation(s)
- Jim N Rose
- Department of Radiation Oncology, British Columbia Cancer Agency, Cancer Centre for the Southern Interior, Kelowna, BC, Canada
| | - Juanita M Crook
- Department of Radiation Oncology, Cancer Centre for the Southern Interior, 399 Royal Avenue, Kelowna, BC, Canada V1Y 5L3
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12
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Broder MS, Gutierrez B, Cherepanov D, Linhares Y. Burden of skeletal-related events in prostate cancer: unmet need in pain improvement. Support Care Cancer 2014; 23:237-47. [PMID: 25270847 DOI: 10.1007/s00520-014-2437-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 09/09/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Up to 75% of patients with prostate cancer experience metastatic bone disease, which leads to an increased risk for skeletal-related events (SREs) including pathological bone fracture, spinal cord compression, and hypercalcemia of malignancy. Our objective was to systematically review the literature on the impact of SREs on quality of life (QOL), morbidity, and survival with a primary focus on the impact of SREs on pain in prostate cancer patients. METHODS We searched PubMed, limiting to peer-reviewed English-language human studies published in 2000-2010. The search was based on the US Food and Drug Administration and European Medicines Agency definition of an SRE, which includes pathologic fracture, spinal cord compression (SCC), hypercalcemia of malignancy, and radiotherapy or surgery to bone resulting from severe bone pain. RESULTS A total of 209 articles were screened, of which 173 were excluded, and 36 were included in this review. Patients with SREs had more pain and worse survival compared with no SREs. Pathologic bone fractures worsened QOL and were associated with shorter survival. Radiation therapy of SCC alleviated pain and improved morbidity. SCC was associated with decreases in patient survival. Radiation therapy and surgery to bone improved pain. CONCLUSIONS Specific SREs are associated with worse outcomes, including increased pain, poorer QOL, morbidity, and survival. Treatment of SREs is associated with improved pain, although there remains a need for more effective treatment of SREs in prostate cancer patients.
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Affiliation(s)
- M S Broder
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr., Suite 404, Beverly Hills, CA, 90212, USA
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Furlan C, Trovo M, Drigo A, Capra E, Trovo MG. Half-body irradiation with tomotherapy for pain palliation in metastatic breast cancer. J Pain Symptom Manage 2014; 47:174-80. [PMID: 23796585 DOI: 10.1016/j.jpainsymman.2013.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/28/2013] [Accepted: 03/19/2013] [Indexed: 01/23/2023]
Abstract
CONTEXT Half-body irradiation (HBI) is the fastest and most effective tool against uncontrolled pain from widespread bone metastases but is somewhat toxic. OBJECTIVES To assess the feasibility of lower HBI with helical tomotherapy in patients with metastatic breast cancer in terms of acute toxicity and delay in chemotherapy administration. METHODS Thirteen breast cancer patients with multiple painful bone metastases to the lower half of the body were enrolled in this prospective trial. Eight patients were receiving chemotherapy. Target volume included all bones from the L3-L4 interface to the femoral shafts. Radiation consisted of 8 Gy in one fraction, delivered with helical tomotherapy. Patients were premedicated only with oral steroids. Pain intensity was scored using the Numeric Rating Scale from 0 to 10. Toxicity was scored using the Common Terminology Criteria for Adverse Events, version 3.0. Quality of life was scored with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, before and 21 days after the radiation course. This trial was approved by the local review board. RESULTS Median follow-up was at seven months (range 2-12 months). All but two patients had pain relief in the radiated field. Six patients stopped their analgesic drug consumption. Toxicity was acceptable: two Grade 3 hematologic toxicities were registered (anemia and leukopenia). Grade 1-2 toxicities were hematologic = 13, fever = 3, nausea = 2, and diarrhea = 1. Three of the eight patients had a delay in chemotherapy administration because of leukopenia or anemia. Twelve patients answered to European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, and an improved quality of life was documented in eight cases. CONCLUSION Lower HBI delivered with helical tomotherapy resulted in a well-tolerated regimen, without significant delay in chemotherapy schedule.
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Affiliation(s)
- Carlo Furlan
- Department of Radiation Oncology, Centro di Riferimento Oncologico (CRO), National Cancer Institute, Aviano, Italy.
| | - Marco Trovo
- Department of Radiation Oncology, Centro di Riferimento Oncologico (CRO), National Cancer Institute, Aviano, Italy
| | - Annalisa Drigo
- Department of Medical Physics, Centro di Riferimento Oncologico (CRO), National Cancer Institute, Aviano, Italy
| | - Elvira Capra
- Department of Medical Physics, Centro di Riferimento Oncologico (CRO), National Cancer Institute, Aviano, Italy
| | - Mauro Gaetano Trovo
- Department of Radiation Oncology, Centro di Riferimento Oncologico (CRO), National Cancer Institute, Aviano, Italy
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Griffioen G, Dahele M, Jeulink M, Senan S, Slotman B, Verbakel WF. Bowel-sparing intensity-modulated radiotherapy (IMRT) for palliation of large-volume pelvic bone metastases: rationale, technique and clinical implementation. Acta Oncol 2013; 52:877-80. [PMID: 23057486 DOI: 10.3109/0284186x.2012.725943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lutz S, Lo SS, Chow E, Sahgal A, Hoskin P. Radiotherapy for metastatic bone disease: current standards and future prospectus. Expert Rev Anticancer Ther 2011; 10:683-95. [PMID: 20470001 DOI: 10.1586/era.10.32] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Changes in population dynamics will require increased end-of-life cancer care in the coming years. Palliative radiotherapy successfully relieves symptoms of advanced cancer, with the most common indication for its use being uncomplicated painful bone metastases. Single-fraction radiotherapy provides successful, time-efficient and cost-effective management of bone metastases. Newer technologies, such as stereotactic body radiotherapy, hold promise for some patients with spine metastases, although their niche has not been properly defined and their use outside of a protocol setting is inappropriate. Surgery should be considered for circumstances of completed or impending pathologic fracture, spinal instability, or spinal cord compression in patients who have adequate performance status and prognosis. Multiple sites of painful metastases may be treated with injectible radiopharmaceuticals or hemibody radiation. The future developments in palliative radiotherapy for bone metastases will mirror several forces affecting all of medicine, including resource allocation, the adoption of clinical guidelines and the integration of newer technologies.
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Affiliation(s)
- Stephen Lutz
- Blanchard Valley Regional Cancer Center, 15990 Medical Drive South, Findlay, OH 45840, USA.
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Clinical tolerance in large field radiotherapy--the knowledge gained over the last ten years. Folia Med (Plovdiv) 2010; 52:14-21. [PMID: 20836392 DOI: 10.2478/v10153-010-0042-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Malignant disorders are still far from being successfully managed in spite of the apparent progress achieved by surgical treatment, high energy radiotherapy (RT) and chemotherapy (CHT). They keep being the second most frequent cause of lethal outcomes both in Bulgaria and in most countries of the world. One of the promising approaches to increasing the efficaciousness of treatment is development and use of methods that are in full accord with the modern requirements of a complex therapy. Over the last fifty years, large field radiation techniques, applied as systemic therapy in oncology, have been investigated and established. These techniques show the transition in oncology to using actively various variants of large field radiotherapy (LFR), the "heavy artillery" of oncoradiologic practice, as an alternative or adjunct therapy to chemotherapy (CHT). In the present paper we review the current knowledge in the field and present the clinical experience accumulated over the last ten years with respect to clinical tolerance in the major large-field radiotherapy techniques--total body irradiation, half body irradiation, whole abdominal irradiation, total and partial lymphoid irradiation. Described in detail are the contemporary knowledge about clinical and hematologic tolerance in total body irradiation as part of the myelo- and nonmyeloablative conditioning regimens as well as in half body irradiation as a systemic therapy in oncology. We also present the amassed experience in clinical tolerance in partial body irradiation in the form of whole abdominal and total or partial lymphoid irradiation. Another point worth noting based again on the experience gained over the last ten years is that for LFR we need to develop a radiotherapy technique that is designed carefully to achieve an optimal therapeutic effect that should include the disease control, good clinical tolerance and reduction of post-radiotherapy sequelae.
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