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Multifraction Radiotherapy for Palliation of Painful Bone Metastases: 20 Gy versus 30 Gy. TUMORI JOURNAL 2015; 101:318-22. [DOI: 10.5301/tj.5000286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2014] [Indexed: 12/22/2022]
Abstract
Aims and Background To compare 2 multifraction radiotherapy schedules in the palliation of painful bone metastases. Methods and Study Design We retrospectively analyzed clinical data of 105 patients with a total of 140 painful bone metastases who were treated with 20 Gy in 5 fractions or 30 Gy in 10 fractions. The primary tumors were breast (30%), lung (28%), and prostate (14%). The main sites of irradiation were spine (n = 79) and sacrum or pelvis (n = 39). Pain was graded by patients according to the pain numeric rating scale just before and 1 month after radiotherapy. Pain progression was defined as an increase ≥2 on pain scale after an initial response. Results The overall response rate at 1 month was 88.6%. Overall response rate was 89.6% in the 20-Gy arm and 87.3% in the 30-Gy arm (p = 0.669). The rate of complete response was statistically better in patients treated with 30 Gy (p = 0.019). The mean reduction in pain was 3.2 in the 20-Gy group and 3.6 in the 30-Gy group. Pain progression was 6.5% and 1.6%, respectively. The incidence of acute toxicity was statistically significantly higher in the 30-Gy arm (23.8%) than in the 20-Gy arm (2.6%) (p = 0.001). One pathologic fracture of the irradiated bone was observed in the 30-Gy arm. Two lesions, one in each group, were re-irradiated for pain recurrence. Pain progression was found in 6.5% of the irradiated lesions in the 20-Gy arm and in 1.6% in the 30-Gy arm. Conclusions In our series, both regimens achieved high rate of pain relief, although the group treated with higher total dose reported better complete response rate. The 30-Gy arm had a significantly higher rate of acute toxicity.
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Rordorf T, Hassan AA, Azim H, Alexandru E, Er O, Gokmen E, Güral Z, Mardiak J, Minchev V, Peintinger F, Szendroi M, Takac I, Tesarova P, Vorobiof D, Vrbanec D, Yildiz R, Yücel S, Zekri J, Oyan B. Bone health in breast cancer patients: a comprehensive statement by CECOG/SAKK Intergroup. Breast 2014; 23:511-25. [PMID: 24986766 DOI: 10.1016/j.breast.2014.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/16/2014] [Accepted: 05/15/2014] [Indexed: 01/07/2023] Open
Abstract
Bone is the most common site of distant metastases in breast cancer that can cause severe and debilitating skeletal related events (SRE) including hypercalcemia of malignancy, pathologic fracture, spinal cord compression and the need for palliative radiation therapy or surgery to the bone. SRE are associated with substantial pain and morbidity leading to frequent hospitalization, impaired quality of life and poor prognosis. The past 25 years of research on the pathophysiology of bone metastases led to the development of highly effective treatment options to delay or prevent osseous metastases and SRE. Management of bone metastases has become an integral part of cancer treatment requiring expertise of multidisciplinary teams of medical and radiation oncologists, surgeons and radiologists in order to find an optimal treatment for each individual patient. A group of international breast cancer experts attended a Skeletal Care Academy Meeting in November 2012 in Istanbul and discussed current preventive measures and treatment options of SRE, which are summarized in this evidence-based consensus for qualified decision- making in clinical practice.
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Affiliation(s)
- Tamara Rordorf
- Department of Oncology, University Hospital, Zürich, Switzerland.
| | | | - Hamdy Azim
- Department of Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eniu Alexandru
- Institute of Oncology "Prof. Dr. Ion Chiricuta" (IOCN), Cluj-Napoca, Romania
| | - Ozlem Er
- Acibadem University, Acibadem Maslak Hospital, Istanbul, Turkey
| | | | - Zeynep Güral
- I.T.F. Radyasyon Onkolojisi Anabilim Dalı, Istanbul, Turkey
| | | | - Velko Minchev
- University Multiprofile Hospital for Active Treatment and Emergency Medicine, Plovdiv, Bulgaria
| | | | | | - Itzok Takac
- Maribor Teaching Hospital, Maribor, Slovenia
| | | | | | | | | | - Serap Yücel
- Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Jamal Zekri
- Jeddah King Faisal Specialist Hospital & Research Centre, Khaldia, Saudi Arabia
| | - Basak Oyan
- Yeditepe University Hospital, Istanbul, Turkey
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Mok F, Li K, Yeung R, Wong KH, Yu B, Wong E, Bedard G, Chow E. 'Who', 'when' and 'how' in re-irradiation of recurrent painful bone metastases. J Bone Oncol 2013; 2:33-7. [PMID: 26909270 PMCID: PMC4723347 DOI: 10.1016/j.jbo.2012.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 12/31/2012] [Indexed: 11/19/2022] Open
Abstract
Re-irradiation of painful bony metastases is increasingly performed since patients are receiving better systemic treatments and having longer life expectancy, and may also be due to the increase use of initial single fraction radiotherapy. However, randomized control trial on the efficacy of re-irradiation is lacking. A recent meta-analysis concluded with a 58% response rate for pain relief by re-irradiation of symptomatic bone metastases. In this review, the effectiveness of re-irradiation in terms of clinical and economical aspects, and clinical questions on who, when, and how to re-irradiate would be discussed. A brief review of other treatment options and comparison with re-irradiation of bone metastases would be performed.
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Affiliation(s)
- Florence Mok
- Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Kenneth Li
- Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Rebecca Yeung
- Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | | | - Brian Yu
- Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Erin Wong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Bedard
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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van Oorschot B, Beckmann G, Schulze W, Rades D, Feyer P. Radiotherapeutic Options for Symptom Control in Breast Cancer. ACTA ACUST UNITED AC 2011; 6:14-19. [PMID: 21547021 DOI: 10.1159/000324564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
SUMMARY: The majority of breast cancer patients will require radiation therapy at some time during the course of their disease. An estimated 30-50% of all radiation treatments are of palliative nature, either to alleviate symptoms or prophylactic to prevent deterioration of quality of life due to locally progressive disease. Radiotherapy is a locally effective tool, and typically causes no systemic and mostly mild acute side effects. The following article provides an overview of options and decision-making in palliative radiotherapy for symptom control.
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