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Matsui JK, Jackson S, Fang J, Million L, Chin AL, Hiniker SM, Kalbasi A, Moding EJ. Effect of palliative radiation dose on symptom response in metastatic sarcomas. Clin Transl Radiat Oncol 2024; 48:100803. [PMID: 38988806 PMCID: PMC11231649 DOI: 10.1016/j.ctro.2024.100803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 07/12/2024] Open
Abstract
Purpose Palliative radiotherapy (RT) plays a crucial role in alleviating symptoms associated with metastatic sarcoma. However, there is a lack of consensus on the optimal palliative radiation dose and fractionation for metastatic sarcomas. We analyzed the association between biologically effective radiation dose and symptom response for patients who underwent palliative RT for metastatic sarcomas. Methods and materials We retrospectively identified patients with metastatic sarcoma treated with palliative RT between 1999 and 2021 at our institution. We assessed the association between equivalent dose in 2 Gy fractions (EQD2) with an α/β of three and symptom relief or overall survival (OS) using univariable and multivariable analyses. Results Of the 198 metastatic sites treated, the most common indications for palliative radiation were pain (n = 181, 91 %) and compression of adjacent structures (n = 16, 8 %). In our analysis, an EQD2 of > 20 Gy was associated with greater rates of short-term symptom relief (n = 143, 85 %) at the RT site compared to an EQD2 of ≤ 20 Gy (n = 14, 54 %, P = 0.001) with no reports of grade 3 or higher toxicity. However, there was no significant improvement in short-term symptom relief for higher radiation doses. Patients treated with an EQD2 of ≤ 20 Gy had a significantly worse performance status, but there was no significant difference in overall survival based on EQD2 on multivariable analysis. Conclusions An EQD2 ≤ 20 Gy (e.g., 8 Gy in 1 fraction) provided inadequate palliative benefit in this series. An EQD2 > 20 Gy resulted in greater rates of symptom palliation in metastatic sarcomas, but further dose escalation did not improve symptom response or durability. These findings suggest standard palliative regimens such as 20 Gy in 5 fractions (EQD2 of 28 Gy) are effective for patients with metastatic sarcomas.
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Affiliation(s)
| | - Scott Jackson
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Judy Fang
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Lynn Million
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Alexander L. Chin
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Susan M. Hiniker
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Anusha Kalbasi
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Everett J. Moding
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
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2
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Casey RT, Hendriks E, Deal C, Waguespack SG, Wiegering V, Redlich A, Akker S, Prasad R, Fassnacht M, Clifton-Bligh R, Amar L, Bornstein S, Canu L, Charmandari E, Chrisoulidou A, Freixes MC, de Krijger R, de Sanctis L, Fojo A, Ghia AJ, Huebner A, Kosmoliaptsis V, Kuehlen M, Raffaelli M, Lussey-Lepoutre C, Marks SD, Nilubol N, Parasiliti-Caprino M, Timmers HHJLM, Zietlow AL, Robledo M, Gimenez-Roqueplo AP, Grossman AB, Taïeb D, Maher ER, Lenders JWM, Eisenhofer G, Jimenez C, Pacak K, Pamporaki C. International consensus statement on the diagnosis and management of phaeochromocytoma and paraganglioma in children and adolescents. Nat Rev Endocrinol 2024:10.1038/s41574-024-01024-5. [PMID: 39147856 DOI: 10.1038/s41574-024-01024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2024] [Indexed: 08/17/2024]
Abstract
Phaeochromocytomas and paragangliomas (PPGL) are rare neuroendocrine tumours that arise not only in adulthood but also in childhood and adolescence. Up to 70-80% of childhood PPGL are hereditary, accounting for a higher incidence of metastatic and/or multifocal PPGL in paediatric patients than in adult patients. Key differences in the tumour biology and management, together with rare disease incidence and therapeutic challenges in paediatric compared with adult patients, mandate close expert cross-disciplinary teamwork. Teams should ideally include adult and paediatric endocrinologists, oncologists, cardiologists, surgeons, geneticists, pathologists, radiologists, clinical psychologists and nuclear medicine physicians. Provision of an international Consensus Statement should improve care and outcomes for children and adolescents with these tumours.
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Affiliation(s)
- Ruth T Casey
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
- Department of Endocrinology, Cambridge Cancer Centre and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Emile Hendriks
- Department of Paediatric Diabetes and Endocrinology, Cambridge Cancer Centre and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cheri Deal
- Endocrine and Diabetes Service, CHU Sainte-Justine and University of Montreal, Montreal, Québec, Canada
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Verena Wiegering
- University Children's Hospital, Department of Paediatric Hematology, Oncology and Stem Cell Transplantation, University of Würzburg, Würzburg, Germany
| | - Antje Redlich
- Paediatric Oncology Department, Otto von Guericke University Children's Hospital, Magdeburg, Germany
| | - Scott Akker
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Rathi Prasad
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Martin Fassnacht
- Department of Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Roderick Clifton-Bligh
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Laurence Amar
- Université de Paris, Paris, France
- Hypertension Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Stefan Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Letizia Canu
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Centro di Ricerca e Innovazione sulle Patologie Surrenaliche, Azienda Ospedaliera Universitaria (AOU) Careggi, Florence, Italy
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Paediatrics, National and Kapodistrian University of Athens Medical School, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | | | - Maria Currás Freixes
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO) and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Ronald de Krijger
- Princess Maxima Center for Paediatric Oncology, Utrecht, Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Luisa de Sanctis
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Antonio Fojo
- Division of Hematology/Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Amol J Ghia
- Department of Radiation Oncology, University Hospital of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Angela Huebner
- Department of Paediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Vasilis Kosmoliaptsis
- Department of Surgery, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
- Blood and Transplant Research Unit in Organ Donation and Transplantation, National Institute for Health Research, University of Cambridge, Cambridge, UK
| | - Michaela Kuehlen
- Paediatrics and Adolescent Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Marco Raffaelli
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Charlotte Lussey-Lepoutre
- Service de médecine nucléaire, Inserm U970, Sorbonne université, Groupe hospitalier Pitié-Salpétrière, Paris, France
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR GOSH Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Naris Nilubol
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mirko Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, Turin, Italy
| | - Henri H J L M Timmers
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Anna Lena Zietlow
- Clinical Child and Adolescent Psychology, Institute of Clinical Psychology and Psychotherapy, Department of Psychology, TU Dresden, Dresden, Germany
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO) and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Anne-Paule Gimenez-Roqueplo
- Université Paris Cité, PARCC, INSERM, Paris, France
- Service de Génétique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Ashley B Grossman
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
- Centre for Endocrinology, Barts and the London School of Medicine, London, UK
- ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Jacques W M Lenders
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Graeme Eisenhofer
- Department of Medicine III, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD, USA
| | - Christina Pamporaki
- Department of Medicine III, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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3
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Cuviello A, Figueroa Guzmán AF, Zeng E, Mothi SS, Baker JN, Krasin MJ. Utilization of Palliative Radiation in Pediatric Oncology Patients During the End-of-life (EOL). J Pain Symptom Manage 2024:S0885-3924(24)00932-1. [PMID: 39151765 DOI: 10.1016/j.jpainsymman.2024.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/05/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Suffering at the end-of-life (EOL) can impact the perception of a "good death" and ultimately affect bereavement for families of children with cancer. Palliative radiation (pXRT) is a tool that can address pain, mitigate suffering and improve quality of life. METHODS A retrospective medical record review of pediatric oncology patients who died over an 11-year period was completed. Descriptive analysis and non-parametric tests to compare groups were used. RESULTS 2202 total deaths occurred during the study period; 167 patients met study criteria, reflecting a 7.6% incidence of pXRT use at the EOL. Most patients were white (68%) and male (59%), with a median age of 9 years. Solid tumors were most common (52%), followed by CNS tumors (38%), and leukemia (10%). pXRT was primarily used to treat pain (37%) and focused on sites including brain/spine (37%), head/neck (24%), and pelvis (12%). Mean radiation dose delivered was 23.8Gy (range: 1.8-55.8Gy) in a median of 7 fractions (range: 1-31). Side effects were rare and 58% of patients had a decrease in reported pain scores. Additionally, 87% received a pediatric palliative care (PPC) consultation which increased the likelihood for hospice referral, documented DNR preferences and decrease episodes of CPR on the day of death. CONCLUSIONS There is underutilization and significant variability in the use of pXRT during EOL in pediatric oncology. Barriers to this tool may include physician perceptions, family/patient preferences, and logistical hardships. Guidelines to standardize pXRT, alongside earlier PPC integration, may guide clinician decision making and increase pXRT utilization.
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Affiliation(s)
| | | | - Emily Zeng
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Justin N Baker
- Division of Quality of Life and Pediatric Palliative Care; Department of Pediatrics; Stanford Medicine Children's Health, Palo Alto, CA, USA
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4
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Guckenberger M, Billiet C, Schnell D, Franzese C, Spałek M, Rogers S, Stelmes JJ, Aebersold DM, Hemmatazad H, Zimmermann F, Zimmer J, Zilli T, Bruni A, Baumert BG, Nägler F, Gut P, Förster R, Madani I. Dose-intensified stereotactic body radiotherapy for painful vertebral metastases: A randomized phase 3 trial. Cancer 2024; 130:2713-2722. [PMID: 38581694 DOI: 10.1002/cncr.35310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The purpose of this randomised study was to determine whether dose-intensified stereotactic body radiotherapy (SBRT) for painful vertebral metastases results in increased rates of pain improvement compared with conventional external beam radiotherapy (cEBRT) (control) 6 months after treatment. METHODS This randomized, controlled phase 3 trial was conducted between November 2016 and January 2023, when it was stopped early. Patients were eligible if they were aged 18 years or older; had one or two painful, stable, or potentially unstable vertebral metastases; and had a life expectancy of 1 year or longer according to the investigator's estimates. Patients received 48.5 grays (Gy) in 10 fractions (with epidural involvement) or 40 Gy in five fractions (without epidural involvement) in the SBRT group and 30 Gy in 10 fractions or 20 Gy in five fractions in the cEBRT group, respectively. The primary end point was an improvement in the pain score at the treated site by at least 2 points (on a visual analog scale from 0 to 10 points) at 6-month follow-up. Data were analyzed on an intention-to-treat and per-protocol basis. RESULTS Of 214 patients who were screened for eligibility, 63 were randomized 1:1 between SBRT (33 patients with 36 metastases) and cEBRT (30 patients with 31 metastases). The median age of all patients was 66 years, and 40 patients were men (63.5%). In the intention-to-treat analysis, the 6-month proportion of patients who had metastases with pain reduction by 2 or more points was significantly higher in the SBRT group versus the control group (69.4% vs. 41.9%, respectively; two-sided p = .02). Changes in opioid medication intake relative to baseline were nonsignificant between the groups. No differences were observed in vertebral compression fracture or adverse event rates between the groups. CONCLUSIONS Dose-intensified SBRT improved pain score more effectively than cEBRT at 6 months.
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Affiliation(s)
- Matthias Guckenberger
- University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | | | | | - Ciro Franzese
- Humanitas University, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Mateusz Spałek
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Jean-Jacques Stelmes
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Luxemburg Health Directorate, Luxemburg, Luxemburg
| | - Daniel M Aebersold
- Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Hossein Hemmatazad
- Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Jörg Zimmer
- Städtisches Klinikum Dresden, Dresden, Germany
| | - Thomas Zilli
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Geneva University Hospital, Geneva, Switzerland
| | | | | | | | | | - Robert Förster
- University Hospital Zurich, Zurich, Switzerland
- Kantonsspital Winterthur, Winterthur, Switzerland
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5
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Kerba M, Lourenco RDA, Sahgal A, Cardet RDF, Siva S, Ding K, Myrehaug SD, Masucci GL, Brundage M, Parulekar WR. An Economic Analysis of SC24 in Canada: A Randomized Study of SBRT Compared With Conventional Palliative RT for Spinal Metastases. Int J Radiat Oncol Biol Phys 2024; 119:1061-1068. [PMID: 38218455 DOI: 10.1016/j.ijrobp.2023.12.052] [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: 12/09/2022] [Revised: 12/19/2023] [Accepted: 12/31/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE The Canadian Cancer Trials Group (CCTG) Symptom Control 24 protocol (SC.24) was a multicenter randomized controlled phase 2/3 trial conducted in Canada and Australia. Patients with painful spinal metastases were randomized to either 24 Gy/2 stereotactic body radiation therapy (SBRT) or 20 Gy/5 conventional external beam radiation therapy (CRT). The study met its primary endpoint and demonstrated superior complete pain response rates at 3 months following SBRT (35%) versus CRT (14%). SBRT planning and delivery is resource intensive. Given its benefits in SC.24, we performed an economic analysis to determine the incremental cost-effectiveness of SBRT compared with CRT. METHODS AND MATERIALS The trial recruited 229 patients. Cost-effectiveness was assessed using a Markov model taking into account observed survival, treatments costs, retreatment, and quality of life over the lifetime of the patient. The EORTC-QLU-C10D was used to determine quality of life values. Transition probabilities for outcomes were from available patient data. Health system costs were from the Canadian health care perspective and were based on 2021 Canadian dollars (CAD). The incremental cost-effectiveness ratio (ICER) was expressed as the ratio of incremental cost to quality-adjusted life years (QALY). The impact of parameter uncertainty was investigated using deterministic and probabilistic sensitivity analyses. RESULTS The base case for SBRT compared with CRT had an ICER of $9,040CAD per QALY gained. Sensitivity analyses demonstrated that the ICER was most sensitive to variations in the utility assigned to "No local failure" ($5,457CAD to $241,051CAD per QALY), adopting low and high estimates of utility and the cost of the SBRT (ICERs ranging from $7345-$123,361CAD per QALY). It was more robust to variations in assumptions around survival and response rate. CONCLUSIONS SBRT is associated with higher upfront costs than CRT. The ICER shows that, within the Canadian health care system, SBRT with 2 fractions is likely to be more cost-effective than CRT.
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Affiliation(s)
- Marc Kerba
- Department of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada.
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rafael De Feria Cardet
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Victoria, Australia
| | - Keyue Ding
- Canadian Clinical Trials Group, Queen's University, Kingston, Ontario, Canada.
| | - Sten D Myrehaug
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Giuseppina L Masucci
- Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Michael Brundage
- Department of Cancer Care and Epidemiology, Queens's University, Kingston, Ontario, Canada
| | - Wendy R Parulekar
- Canadian Clinical Trials Group, Queen's University, Kingston, Ontario, Canada
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Gal O, Rothrock RJ, Gutierrez AN, Mehta MP, Kotecha R. Stereotactic Body Radiation Therapy Versus Conventional Radiation Therapy for Painful Spinal Metastases: A Comparative Analysis of Randomized Trials and Practical Considerations. Pract Radiat Oncol 2024:S1879-8500(24)00149-8. [PMID: 38977158 DOI: 10.1016/j.prro.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE Recent randomized trials have compared the efficacy and safety of stereotactic body radiation therapy (SBRT) with those of standard conventional external beam radiation therapy (cEBRT) for the treatment of painful spinal metastases. We conducted a composite analysis of these trials in order to inform current practice using pooled outcomes. METHODS AND MATERIALS Data from each randomized trial were abstracted from the final publications with biologically effective doses (BEDs) recalculated for SBRT and cEBRT. Primary outcome measures were overall pain response (OR) and complete pain response (CR) rates at 1, 3, and 6 months and rates of vertebral compression fracture. Random effects models were used to estimate primary outcome measures, and meta-regression assessed the effect of BED. RESULTS Four prospective randomized clinical trials published between 2018 and 2024 were included, with a total of 686 patients (383 and 303 in the SBRT and cEBRT groups, respectively). Dose and fraction (fx) number ranged from 24 Gy/1 fx to 48.5 Gy/10 fx for the SBRT group (median BED using an α-to-β ratio of 10, 50 Gy) and from 8 Gy/1 fx to 30 Gy/10 fx for the cEBRT group (median BED using an α-to-β ratio of 10, 28 Gy). The 1-, 3-, and 6-month OR rates for SBRT and cEBRT were similar: 53.6%, 52.4%, and 58.8% versus 48.4%, 47.9%, and 43.8%, respectively (p > .05). The 3-month CR rate was significantly higher for SBRT than for cEBRT (31.9% vs 14.8%; risk ratio, 2.26; 95% CI, 1.48-3.45; p < .001), but not the 6-month rate (34.4% vs 16.3%; risk ratio, 1.83; 95% CI, 0.74-4.53; p = .194). Vertebral compression fracture rates were similar at 17.3% and 18.4% for SBRT and cEBRT, respectively. No significant dose-dependent effect was observed with increasing BED for any efficacy or safety outcomes. CONCLUSIONS OR rates are similar, but CR rates appear higher with SBRT than with cEBRT, yet no dose-dependent effects were identified despite approximately 1.8 × BED dose with SBRT.
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Affiliation(s)
- Omer Gal
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Robert J Rothrock
- Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Alonso N Gutierrez
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
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7
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Roth C, Weiss K. Palliative Care Needs of Patients with Musculoskeletal Malignancies. Curr Oncol Rep 2024; 26:784-790. [PMID: 38789669 DOI: 10.1007/s11912-024-01543-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE OF REVIEW This review aims to assess the literature regarding current treatment options for the palliative care of patients with advanced musculoskeletal malignancies whether primary or metastatic. RECENT FINDINGS The inclusion of specialized palliative care physicians, in conjunction with surgeons, medical oncologists, radiation oncologists, interventional radiologists, and mental health professionals, results in better control of end-of-life symptoms in both children and adults with terminal musculoskeletal malignancies. The palliative care of patients with musculoskeletal malignancies requires a multi-disciplinary team and benefits from specialized palliative care physicians. The unique impacts of musculoskeletal malignancies on ambulation and independence creates additional mental and physical burdens on patients and care-takers alike. Palliative care should focus on preserving ambulatory function and patient independence, in addition to managing chronic pain and other end-of-life symptoms common to these malignancies.
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Affiliation(s)
- Clark Roth
- Division of Orthopedic Oncology, Department of Orthopedic Surgery, The University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Kurt Weiss
- Division of Orthopedic Oncology, Department of Orthopedic Surgery, The University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
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8
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Kim JH, Shin JY, Lee SY. Treatment of Pelvic and Spinal Bone Metastases: Radiotherapy and Hyperthermia Alone vs. in Combination. Cancers (Basel) 2024; 16:1604. [PMID: 38672685 PMCID: PMC11049148 DOI: 10.3390/cancers16081604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Painful pelvic and spinal bone metastases are a considerable challenge for doctors and patients. Conventional therapies include morphine-equivalent medication (MeM) and local radiotherapy (RT), but these interventions are not always successful. More recently, hyperthermia (HT) has been applied to complement RT and MeM, and this complex approach has shown promising synergistic results. The objective of our study was to present the results of RT combined with a special kind of HT (modulated electrohyperthermia, mEHT), in which some of the thermal effect is contributed by equivalent nonthermal components, drastically reducing the necessary power and energy. This retrospective study included 61 patients divided into three groups with pelvic and spinal bone metastases to compare the effects of RT and mEHT alone and in combination (RT + mEHT). A detailed evaluation of pain intensity, measured by the brief pain inventory score, MeM use, and breakthrough pain episodes, revealed no significant differences between RT and mEHT alone; thus, these individual methods were considered equivalent. However, RT + mEHT yielded significantly better results in terms of the above parameters. Clinically, mEHT has a lower risk of adverse thermal effects, and due to its efficacy, mEHT can be used to treat RT-resistant lesions.
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Affiliation(s)
- Jong-Hun Kim
- Division of Thoracic and Cardiovascular Surgery, Jeonbuk National University Hospital-Jeonbuk National University Medical School, Jeonju 54907, Republic of Korea;
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea;
| | - Jin-Yong Shin
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea;
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Hospital-Jeonbuk National University Medical School, Jeonju 54907, Republic of Korea
| | - Sun-Young Lee
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea;
- Department of Radiation Oncology, Jeonbuk National University Hospital-Jeonbuk National University Medical School, Jeonju 54907, Republic of Korea
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Lee JH, Shi DD, Shin KY, Buckley E, Gunasti L, Hall E, Mann E, Spicer B, Chen YH, Hammoudeh L, Brennan V, Huynh MA, Spektor A, Krishnan MS, Balboni TA, Hertan LM. A Prospective Study Assessing the Efficacy and Toxicity of Stereotactic Body Radiation Therapy for Oligometastatic Bone Metastases. Adv Radiat Oncol 2024; 9:101411. [PMID: 38406391 PMCID: PMC10884444 DOI: 10.1016/j.adro.2023.101411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/17/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose Stereotactic body radiation therapy (SBRT) is a promising treatment for oligometastatic disease in bone because of its delivery of high dose to target tissue and minimal dose to surrounding tissue. The purpose of this study is to assess the efficacy and toxicity of this treatment in patients with previously unirradiated oligometastatic bony disease. Methods and Materials In this prospective phase II trial, patients with oligometastatic bone disease, defined as ≤3 active sites of disease, were treated with SBRT at Brigham and Women's Hospital/Dana Farber Cancer Center and Beth Israel Deaconess Medical Center between December 2016 and May 2019. SBRT dose and fractionation regimen were not protocol mandated. Local progression-free survival, progression-free survival, prostatic specific antigen progression, and overall survival were reported. Treatment-related toxicity was also reported. Results A total of 98 patients and 126 lesions arising from various tumor histologies were included in this study. The median age of patients enrolled was 72.8 years (80.6% male, 19.4% female). Median follow-up was 26.7 months. The most common histology was prostate cancer (68.4%, 67/98). The most common dose prescriptions were 27/30 Gy in 3 fractions (27.0%, 34/126), 30 Gy in 5 fractions (16.7%, 21/126), or 30/35 Gy in 5 fractions (16.7%, 21/126). Multiple doses per treatment regimen reflect dose painting employing the lower dose to the clinical target volume and higher dose to the gross tumor volume. Four patients (4.1%, 4/98) experienced local progression at 1 site for each patient (3.2%, 4/126). Among the entire cohort, 2-year local progression-free survival (including death without local progression) was 84.8%, 2-year progression-free survival (including deaths as well as local, distant, and prostatic specific antigen progression) was 47.5%, and 2-year overall survival was 87.3%. Twenty-six patients (26.5%, 26/98) developed treatment-related toxicities. Conclusions Our study supports existing literature in showing that SBRT is effective and tolerable in patients with oligometastatic bone disease. Larger phase III trials are necessary and reasonable to determine long-term efficacy and toxicities.
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Affiliation(s)
- Joyce H. Lee
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Diana D. Shi
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Kee-Young Shin
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elizabeth Buckley
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Lauren Gunasti
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Emily Hall
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Eileen Mann
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Beverly Spicer
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Yu-Hui Chen
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lubna Hammoudeh
- Knight Cancer Institute Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Victoria Brennan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mai Anh Huynh
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Alexander Spektor
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Monica S. Krishnan
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Tracy A. Balboni
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Lauren M. Hertan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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10
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Thibodeau S, Paulin G, Ynoe Moraes F. Lessons learned for spine SABR? Clin Transl Radiat Oncol 2024; 45:100728. [PMID: 38304240 PMCID: PMC10830517 DOI: 10.1016/j.ctro.2024.100728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 02/03/2024] Open
Abstract
•SABR has shown survival benefits in oligometastatic cases, particularly in low-volume metastatic disease states.•Spine SABR offers potential improvements in local control, and pain response for metastatic spine tumors.•Technical requirements for SABR, like advanced image guidance and immobilization systems, are increasingly available.•Current data suggests high local control rates (75-95%) and variable pain responses (40-90%) with SABR using single or multi-fraction regimens.•Further randomized trials are needed to explore SABR applications in different scenarios and populations, while considering global health aspects for wider accessibility.
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Affiliation(s)
- Stephane Thibodeau
- Department of Oncology, Queen’s University Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Gregory Paulin
- Department of Oncology, Queen’s University Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Fabio Ynoe Moraes
- Department of Oncology, Queen’s University Kingston Health Sciences Centre, Kingston, ON, Canada
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil
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11
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Ahmed S, Prakash A, Kumar Upadhyay A. Evaluation of Different Regimens of Palliative Radiation Therapy for Symptomatic Bone Metastases: An Audit From a Tertiary Care Hospital in Jharkhand, India. Cureus 2024; 16:e53622. [PMID: 38449966 PMCID: PMC10916909 DOI: 10.7759/cureus.53622] [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] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Background This study aimed to assess the efficacy of different radiation therapy regimens in treating patients with symptomatic bone metastases. Methodology A retrospective study was conducted by assigning patients with symptomatic bone metastases from different primary cancers into three groups, namely, Arms A, B, and C. The radiation dose delivered in each arm was as follows: 8 Gray (Gy) in a single fraction for Arm A, 20 Gy in five fractions at the rate of 4 Gy per fraction for Arm B, and 30 Gy in 10 fractions at the rate of 3 Gy per fraction for Arm C. Each arm consisted of 15 patients. A comparison was conducted across all three arms to evaluate pain relief based on the Visual Analog Scale (VAS), performance score improvement based on the Eastern Cooperative Oncology Group (ECOG), and analgesic requirement based on the World Health Organization (WHO) step ladder at one week, one month, and three months. Results The pain relief was measured using the VAS in three different arms, i.e., Arm A, B, and C. After one week, the pain relief was 66.67%, 60%, and 60%, respectively. After one month, it was 73.33% in all three arms. At three months, it was 80%, 86.67%, and 86.67%, respectively. The study also measured the improvement in the ECOG performance score. The improvement in all three arms was 60% after one week and 66.67% in Arm A and 73.33% in Arms B and C after one month. After three months, the improvement was 73.33%, 80%, and 80% in Arms A, B, and C, respectively. The decrease in analgesic usage was also measured in all three arms. After one week, it was 60% in all three arms. After one month, it was 66.67%, 73.33%, and 73.33% in Arms A, B, and C, respectively. At three months, it was 73.33%, 80%, and 80% in Arms A, B, and C, respectively. No significant statistical difference was found between the three arms. Conclusions The efficacy of a single 8 Gy arm was almost equivalent to that of other arms of multifractionated regimens in terms of improvement in pain and performance score and decreased use of analgesics for a short duration of follow-up. For high-volume cancer centers and patients with economic constraints, a single-fraction regime provides effective palliation for painful bone metastases.
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Affiliation(s)
- Suhail Ahmed
- Radiation Oncology, Meherbai Tata Memorial Hospital, Jamshedpur, IND
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12
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Chen W, Yang C, Chen B, Xi M, Chen B, Li Q. Management of metastatic bone disease of melanoma. Melanoma Res 2024; 34:22-30. [PMID: 37939058 DOI: 10.1097/cmr.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
One of the most aggressive tumors arising from the skin, mucosa, and uvea is malignant melanoma, which easily metastasizes. Bone tissue is one of the most typical locations for distant metastasis, and around 5%-20% of patients eventually acquired skeletal metastases. For decades, the incidence of bone metastases was higher, bringing greater burden on the family, society, and healthcare system owing to the progress of targeted therapy and immunotherapy, which prolonging the survival time substantially. Moreover, bone metastases result in skeletal-related events, which influence the quality of life, obviously. Appropriate intervention is therefore crucial. To obtain the optimum cost-effectiveness, existing treatment algorithm must be integrated, which is still controversial. We have aimed to throw light on current views concerning the formation, biological and clinical features, and treatment protocol of melanoma bone metastases to guide the decision-making process.
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Affiliation(s)
- Wenyan Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine
- Guangdong Esophageal Cancer Research Institute
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China
| | - Chen Yang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine
- Guangdong Esophageal Cancer Research Institute
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China
| | - Biqi Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine
- Guangdong Esophageal Cancer Research Institute
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China
| | - Mian Xi
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine
- Guangdong Esophageal Cancer Research Institute
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China
| | - Baoqing Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine
- Guangdong Esophageal Cancer Research Institute
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China
| | - Qiaoqiao Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine
- Guangdong Esophageal Cancer Research Institute
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China
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13
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He M, Wang D, Li H, Sun M, Yan P, Zhang Y, Li L, Yu D, Wang X, Hu Y. Value of CT-based radiomics in evaluating the response of bone metastases to systemic drug therapy in breast cancer patients. Thorac Cancer 2024; 15:361-368. [PMID: 38155425 PMCID: PMC10864122 DOI: 10.1111/1759-7714.15199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND This study aimed to investigate the value of nonenhanced computed tomography (CT)-based radiomics in determining disease progression in breast cancer patients with bone marrow metastases and to develop a model for assessing treatment efficacy. METHODS A total of 134 breast cancer patients with bone metastases were enrolled from three hospitals. Nonenhanced CT was performed after two cycles of drug treatment. The images were categorized into an invalid and a valid group according to disease progression status. The largest osteolytic lesions' maximum cross-sections in the CT images were selected as regions of interest (ROIs) for feature extraction. Variance threshold, SelectKBest, and least absolute shrinkage and selection operator (LASSO) were used to reduce feature dimensionality. K-nearest neighbor algorithm (KNN), support vector machine (SVM), extreme gradient boosting (XGBoost), random forest (RF), logistic regression (LR), and decision tree (DT) algorithms were trained to establish radiomics models. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic performance of the models. RESULTS The KNN classifier demonstrated the best performance compared to the random grouping method. In the validation group, the area under the ROC curve (AUC) was 0.810. In the cross-validation method, the RF classifier showed the best performance with an AUC of 0.84. CONCLUSION Nonenhanced CT-based radiomics provides a promising method for evaluating the efficacy of systemic drug therapy in breast cancer patients with osteolytic bone metastases.
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Affiliation(s)
- Miao He
- Department of Medical OncologyQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
- Department of Medical OncologyQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Dongdong Wang
- Department of RadiologyQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
| | - Huijie Li
- Department of OncologyAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanChina
| | - Meili Sun
- Department of OncologyJinan Central Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
- Department of OncologyCentral Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Peng Yan
- Department of OncologyJinan Central Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
- Department of OncologyCentral Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Yongyuan Zhang
- Department of Medical AffairsQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
| | - Li Li
- Department of Medical OncologyQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
| | - Dexin Yu
- Department of RadiologyQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
| | - Xiuwen Wang
- Department of Medical OncologyQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
| | - Yu Hu
- Department of Medical OncologyQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
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14
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Peters C, Vandewiele J, Lievens Y, van Eijkeren M, Fonteyne V, Boterberg T, Deseyne P, Veldeman L, De Neve W, Monten C, Braems S, Duprez F, Vandecasteele K, Ost P. Incidence and radiotherapy treatment patterns of complicated bone metastases. J Bone Oncol 2024; 44:100519. [PMID: 38179260 PMCID: PMC10765249 DOI: 10.1016/j.jbo.2023.100519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024] Open
Abstract
Background Despite the encouraging results of the SCORAD trial, single fraction radiotherapy (SFRT) remains underused for patients with complicated bone metastases with rates as low as 18-39%. We aimed to evaluate the incidence and treatment patterns of these metastases in patients being referred to a tertiary centre for palliative radiotherapy. Materials and methods We performed a retrospective review of all bone metastases treated at our centre from January 2013 until December 2017. Lesions were classified as uncomplicated or complicated. Complicated was defined as associated with (impending) fracture, existing spinal cord or cauda equina compression. Our protocol suggests using SFRT for all patients with complicated bone metastases, except for those with symptomatic neuraxial compression and a life expectancy of ≥28 weeks. Results Overall, 37 % of all bone metastases were classified as complicated. Most often as a result of an (impending) fracture (56 %) or spinal cord compression (44 %). In 93 % of cases, complicated lesions were located in the spine, most commonly originating from prostate, breast and lung cancer (60 %). Median survival of patients with complicated bone metastases was 4 months. The use of SFRT for complicated bone metastases increased from 51 % to 85 % over the study period, reaching 100 % for patients with the poorest prognosis. Conclusions Approximately 37 % of bone metastases are classified as complicated with the majority related to (impending) fracture. Patients with complicated bone metastases have a median survival of 4 months and were mostly treated with SFRT.
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Affiliation(s)
- Cedric Peters
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Julie Vandewiele
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Marc van Eijkeren
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Pieter Deseyne
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Liv Veldeman
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Wilfried De Neve
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Chris Monten
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Sabine Braems
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Katrien Vandecasteele
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
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15
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Faghihi Moghaddam F, Bakhshandeh M, Mofid B, Sahinbas H, Faeghi F, Mirzaei H, Rakhsha A, Yousefi Kashi AS, Sadeghi R, Mahdavi A. Clinical effectiveness of combined whole body hyperthermia and external beam radiation therapy (EBRT) versus EBRT alone in patients with painful bony metastases: A phase III clinical trial study. J Therm Biol 2024; 120:103804. [PMID: 38460451 DOI: 10.1016/j.jtherbio.2024.103804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 11/13/2023] [Accepted: 01/23/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE To evaluate the response rate, pain relief duration, and time it took for pain to decline or resolve after radiation therapy (RT) with or without fever-range Whole Body Hyperthermia (WBH) in bony metastatic patients with mainly primary tumor of prostate and breast cancer leading to bone pain. MATERIALS & METHODS Bony metastatic patients with pain score ≥4 on the Brief Pain Inventory (BPI) underwent RT of 30 Gy in 10 fractions in combination with WBH with nursing care under medical supervision versus RT-alone. WBH application time was 3-4 h in three fractions with at least 48-h intervals. All patients were stratified primary site, breast or prostate cancer vs others, BPI score, and exclusion criteria. The primary endpoint was complete response (CR) (BPI equal to zero with no increase of analgesics) within two months of follow-up. RESULTS Based on this study, the RT-alone group showed the worst pain. The study was terminated after the enrollment of a total of 61 patients, 5 years after the first enrollment (April 2016 to February 2021). Finally, the CR rate in RT + WBH revealed the most significant difference with RT-alone, 47.4% versus 5.3% respectively within 2 months post-treatment (P-value <0.05). The time of complete pain relief was 10 days for RT + WBH, while the endpoint was not reached during the RT-alone arm. Pain progression or stable disease was observed in half of the patients in RT-alone group within 4 weeks after treatment. However, this score was near zero in RT + WBHT patients in two months post-treatment. CONCLUSIONS WBH plus RT showed significant increases in pain relief and shorter response time in comparison with RT-alone for patients with bone metastatic lesions.
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Affiliation(s)
- Fahimeh Faghihi Moghaddam
- Biomedical Engineering and Medical Physics Department, Faculty of Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Bakhshandeh
- Department of Radiation Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Bahram Mofid
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hüseyin Sahinbas
- Institute for Hyperthermia Research, Partner of the Marien Hospital Herne, Hospital of the RuhrUniversity, Bochum, Germany
| | - Fariborz Faeghi
- Department of Radiation Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mirzaei
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Rakhsha
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Shahram Yousefi Kashi
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Sadeghi
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Mahdavi
- Department of Radiology, Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Yuan X, Chen J, Shi D, Song J, Wang P, Cheng D, Yang C, Qiu X, Zhai C. Advanced esophageal cancer with bone metastases: Prognostic biomarkers and palliative treatment. Heliyon 2024; 10:e23510. [PMID: 38170113 PMCID: PMC10758821 DOI: 10.1016/j.heliyon.2023.e23510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/16/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Esophageal cancer (EC) is a common and devastating tumor of the upper digestive tract. Unfortunately, by the time any symptoms have manifested, the disease has often progressed to an advanced stage and is accompanied by macro- and micrometastases, including in the bones. The treatment of esophageal cancer with bone metastases remains clinically challenging, given the poor prognosis associated with this condition. Effective prognostic biomarkers can help medical staff choose the appropriate operation and treatment plan, that is for most beneficial for making patients. Current treatments for esophageal cancer with bone metastases include pain-relieving drugs, surgical therapy, radiotherapy (RT), chemotherapy (CT, including molecular-targeted drug therapy), endocrine therapy (ET), bisphosphonates (BPs) and interventional therapy. Of these robust measures, radiotherapy has emerged as a particularly promising therapy for bone metastases from esophageal cancer. Substantial progress has been made in radiation therapy techniques since the discovery of X-rays by Roentgen in 1895. In its palliative capacity, the key goals of radiotherapy are to relieve the patients' bone pain and debilitate effects, including relieving spinal cord compression, correcting the spinal deformity and restoring spinal stability. However, it is worth mentioning that RT for esophageal cancer has various side effects. Currently, the available studies focused exclusively on radiotherapy for ECBM are too small to draw any definitive conclusions, and each of these studies has significant limitations. In this review, in addition to the epidemiology described at the beginning, we will explore the current prognostic biomarkers and radiotherapy for esophageal cancer, with a particular focus on those with bone metastases.
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Affiliation(s)
- Xiaofeng Yuan
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jun Chen
- Department of Orthopedics, Yixing People's Hospital, Yixing, China
| | - Dingsen Shi
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jiaxun Song
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Pu Wang
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Dong Cheng
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Cheng Yang
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xubin Qiu
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Chenjun Zhai
- Department of Orthopedics, Yixing People's Hospital, Yixing, China
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17
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Guninski RS, Cuccia F, Alongi F, Andratschke N, Belka C, Bellut D, Dahele M, Josipovic M, Kroese TE, Mancosu P, Minniti G, Niyazi M, Ricardi U, Munck Af Rosenschold P, Sahgal A, Tsang Y, Verbakel WFAR, Guckenberger M. Efficacy and safety of SBRT for spine metastases: A systematic review and meta-analysis for preparation of an ESTRO practice guideline. Radiother Oncol 2024; 190:109969. [PMID: 37922993 DOI: 10.1016/j.radonc.2023.109969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND AND PURPOSE Advances in characterizing cancer biology and the growing availability of novel targeted agents and immune therapeutics have significantly changed the prognosis of many patients with metastatic disease. Palliative radiotherapy needs to adapt to these developments. In this study, we summarize the available evidence for stereotactic body radiotherapy (SBRT) in the treatment of spinal metastases. MATERIALS AND METHODS A systematic review and meta-analysis was performed using PRISMA methodology, including publications from January 2005 to September 2021, with the exception of the randomized phase III trial RTOG-0631 which was added in April 2023. Re-irradiation was excluded. For meta-analysis, a random-effects model was used to pool the data. Heterogeneity was assessed with the I2-test, assuming substantial and considerable as I2 > 50 % and I2 > 75 %, respectively. A p-value < 0.05 was considered statistically significant. RESULTS A total of 69 studies assessing the outcomes of 7236 metastases in 5736 patients were analyzed. SBRT for spine metastases showed high efficacy, with a pooled overall pain response rate of 83 % (95 % confidence interval [CI] 68 %-94 %), pooled complete pain response of 36 % (95 % CI: 20 %-53 %), and 1-year local control rate of 94 % (95 % CI: 86 %-99 %), although with high levels of heterogeneity among studies (I2 = 93 %, I2 = 86 %, and 86 %, respectively). Furthermore, SBRT was safe, with a pooled vertebral fracture rate of 9 % (95 % CI: 4 %-16 %), pooled radiation induced myelopathy rate of 0 % (95 % CI 0-2 %), and pooled pain flare rate of 6 % (95 % CI: 3 %-17 %), although with mixed levels of heterogeneity among the studies (I2 = 92 %, I2 = 0 %, and 95 %, respectively). Only 1.7 % of vertebral fractures required surgical stabilization. CONCLUSION Spine SBRT is characterized by a favorable efficacy and safety profile, providing durable results for pain control and disease control, which is particularly relevant for oligometastatic patients.
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Affiliation(s)
- R S Guninski
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - F Cuccia
- ARNAS Civico Hospital, Radiation Oncology Unit, Palermo, Italy
| | - F Alongi
- Advanced Radiation Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar-Verona, Italy. University of Brescia, Italy
| | - N Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - C Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany. German Cancer Consortium (DKTK), partner site Munich, Munich, Germany. Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - D Bellut
- University Hospital Zurich, University of Zurich, Department of Neurosurgery. Zurich, Switzerland
| | - M Dahele
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiation Oncology and Cancer Center Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - M Josipovic
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - T E Kroese
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - P Mancosu
- IRCCS Humanitas Research Hospital, Medical Physics Unit, Radiation Oncology department, via Manzoni 56, I-20089 Rozzano, Milan, Italy
| | - G Minniti
- Department of Radiological Sciences, Oncology and Anatomical PathologySapienza University of Rome, Rome; IRCCS Neuromed, Pozzilli, IS, Italy
| | - M Niyazi
- Department of Radiation Oncology, University hospital Tübingen, Tübingen, Germany
| | - U Ricardi
- University of Turin, Department of Oncology, Turin, Italy
| | - P Munck Af Rosenschold
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden; Medical Radiation Physics, Lund University, Lund, Sweden
| | - A Sahgal
- Odette Cancer Center of the Sunnybrook Health Sciences Center, Department of Radiation Oncology, Toronto, Canada
| | - Y Tsang
- Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada
| | - W F A R Verbakel
- Amsterdam University Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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18
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Bianchi SP, Faccenda V, Pacifico P, Parma G, Saufi S, Ferrario F, Belmonte M, Sala L, De Ponti E, Panizza D, Arcangeli S. Short-term pain control after palliative radiotherapy for uncomplicated bone metastases: a prospective cohort study. Med Oncol 2023; 41:13. [PMID: 38079079 DOI: 10.1007/s12032-023-02238-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/04/2023] [Indexed: 12/18/2023]
Abstract
This study aimed at evaluating the efficacy of different radiotherapy (RT) fractionation regimens in managing uncomplicated painful bone metastases (BM) and identifying predictive factors for pain control. Patients with 1 to 4 symptomatic BM from any primary solid tumors and a life expectancy exceeding 3 months were included in the study and received palliative RT, with SBRT restricted in the context of oligometastatic disease or in patients with good prognosis. Pain analysis using the Brief Pain Inventory (BPI) tool was conducted at baseline, 1 and 3 months after RT. Analgesic intake was recorded as morphine-equivalent doses (OME). Pain response was assessed using the International Consensus on Palliative Radiotherapy Endpoint (ICPRE). Multivariate logistic regression analyzed patient-related, tumor-related, and treatment-related factors predicting BM pain control at 3 months post-RT. From Feb 2022 to Feb 2023, 44 patients with 65 symptomatic BM were investigated. Breast (32%) and lung (24%) tumors were the most common primary tumors. Treatment plans included 3DCRT (60%) and VMAT (40%), with a median biological effective dose for tumors (BED) of 29 Gy [14-108]. All patients completed the 3-month follow-up. Pain response rates were 62% at 1 month and 60% at 3 months. Responders had better PS ECOG scores (67%; P = 0.008) and received active systemic therapies (67%: P = 0.036). Non-responders had lower pretreatment BPI (mean: 13.7 vs. 58.2; P = 0.032), with significantly higher values after 1 month (mean: 9.1 vs. 5.3, P = 0.033). Baseline BPI (OR: 1.17; 95% CI: 1.032-1.327; P = 0.014) and BPI at 1 month (OR: 0.83; 95% CI: 0.698-0.976; P = 0.025) were independent predictors of pain response at 3 months. Our findings show that palliative RT ensured short-term pain control in patients with BM, regardless of tumor type and dose-fractionation regimen. A larger sample size and a longer follow-up could potentially identify which patients are likely to benefit most from RT, and which fractionation might be indicated for achieving a durable pain relief. A multidisciplinary approach is paramount to provide a better care to BM patients.
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Affiliation(s)
- Sofia Paola Bianchi
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Valeria Faccenda
- Medical Physics Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Pietro Pacifico
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Gaia Parma
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Sara Saufi
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Federica Ferrario
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Maria Belmonte
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Luca Sala
- Clinical Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Elena De Ponti
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Medical Physics Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Denis Panizza
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Medical Physics Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Stefano Arcangeli
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
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19
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Wong HCY, Lee SF, Chan AW, Caini S, Hoskin P, Simone CB, Johnstone P, van der Linden Y, van der Velden JM, Martin E, Alcorn S, Johnstone C, Isabelle Choi J, Nader Marta G, Oldenburger E, Raman S, Rembielak A, Vassiliou V, Bonomo P, Nguyen QN, Chow E, Ryu S. Stereotactic body radiation therapy versus conventional external beam radiotherapy for spinal metastases: A systematic review and meta-analysis of randomized controlled trials. Radiother Oncol 2023; 189:109914. [PMID: 37739318 DOI: 10.1016/j.radonc.2023.109914] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION This study aimed to compare SBRT and cEBRT for treating spinal metastases through a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS PubMed, EMBASE and Cochrane Library were searched up to 6 May 2023 for RCTs comparing SBRT and cEBRT for spinal metastases. Overall and complete pain response, local progression, overall survival, quality of life and adverse events were extracted. Data were pooled using random-effects models. Results were reported as risk ratios (RRs) for dichotomous outcomes, and hazard ratios (HRs) for time-to-event outcomes, along with their 95% confidence intervals (CIs). Heterogeneity was evaluated using the I2 statistic. RESULTS Three RCTs were identified involving 642 patients. No differences were seen in overall pain response comparing SBRT and cEBRT (RR at 3 months: 1.12, 95% CI, 0.74-1.70, p = 0.59; RR at 6 months: 1.29, 95% CI, 0.97-1.72, p = 0.08). Only two of three studies presented complete pain response data. SBRT demonstrated a statistically significant improvement in complete pain response compared to cEBRT (RR at 3 months: 2.52; 95% CI, 1.58-4.01; P < 0.0001; RR at 6 months: 2.48; 95% CI, 1.23-4.99; P = 0.01). There were no significant differences in local progression and overall survival. Adverse events were similar, except for any grade radiation dermatitis, which was significantly lower in SBRT arm (RR 0.17, 95% CI 0.03-0.96, P = 0.04). CONCLUSION SBRT is a safe treatment option for spine metastases. It may provide better complete pain response compared to cEBRT. Additional trials are needed to determine the potential benefits of SBRT in specific patient subsets.
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Affiliation(s)
- Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China.
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom; Division of Cancer Sciences, University of Manchester, United Kingdom
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
| | - Peter Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Yvette van der Linden
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands; Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Joanne M van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Emily Martin
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, LA, USA
| | - Sara Alcorn
- Department of Radiation Oncology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Candice Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Isabelle Choi
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Latin America Cooperative Oncology Group (LACOG), Brazil
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Agata Rembielak
- Division of Cancer Sciences, University of Manchester, United Kingdom; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Vassilios Vassiliou
- Bank of Cyprus Oncology Centre, Department of Radiation Oncology, Nicosia, Cyprus
| | - Pierluigi Bonomo
- Department of Oncology, Azienda, Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University Hospital, New York, NY, USA
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20
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Davis MP, Vanenkevort E, Young A, Wojtowicz M, Gupta M, Lagerman B, Liu E, Mackley H, Panikkar R. Radiation Therapy in the Last Month of Life: Association With Aggressive Care at the End of Life. J Pain Symptom Manage 2023; 66:638-646. [PMID: 37657725 DOI: 10.1016/j.jpainsymman.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023]
Abstract
CONTEXT Half of the patients with cancer who undergo radiation therapy do so with palliative intent. OBJECTIVES To determine the proportion of undergoing radiation in the last month of life, patient characteristics, cancer course, the type and duration of radiation, whether palliative care was involved, and the of radiation with aggressive cancer care metrics. METHODS One thousand seven hundred twenty-seven patients who died of cancer between January 1, 2018, and December 31, 2019, were included. Demographics, cancer stage, palliative care referral, advance directives, use of home health care, radiation timing, and survival were collected. Type of radiation, course, and intent were reviewed. Chi-square analysis was utilized for categorical variables, and Kruskal-Wallis tests for continuous variables. A stepwise selection was used to build a Cox proportional hazard model. RESULTS Two hundred thirty-three patients underwent radiation in the last month of life. Younger patients underwent radiation 67.3 years (SD 11.52) versus 69.2 years (SD 11.96). 42.6% had radiation within two weeks of death. The average fraction number was 5.5. Individuals undergoing radiation were more likely to start chemotherapy within the last 30 days of life, continue chemotherapy within two weeks of death, be admitted to the ICU, and have two or more hospitalizations or emergency room visits. Survival measured from the date of diagnosis was shorter for those undergoing radiation, 122 days (IQR 58-462) versus 474 days (IQR 225-1150). Palliative care consultations occurred later in those undergoing radiation therapy. CONCLUSION Radiation therapy in the last month of life occurs in younger patients with rapidly progressive cancer, who are subject to more aggressive cancer care, and have late palliative care consults.
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Affiliation(s)
- Mellar P Davis
- Department of Palliative Care (M.P.D.), Geisinger Medical Center, Danville, Pennsylvania.
| | - Erin Vanenkevort
- Department of Population and Health Science (E.V., A.Y.), Research Institute Geisinger Health System, Danville, Pennsylvania
| | - Amanda Young
- Department of Population and Health Science (E.V., A.Y.), Research Institute Geisinger Health System, Danville, Pennsylvania
| | - Mark Wojtowicz
- Oncology Research Department (M.W.), Cancer Institute, Geisinger Medical Center, Danville, Pennsylvania
| | - Mudit Gupta
- Department of Phenomics Analytics and Clinical Data Core (M.G., B.L.), Geisinger Health System, Danville, Pennsylvania
| | - Braxton Lagerman
- Department of Phenomics Analytics and Clinical Data Core (M.G., B.L.), Geisinger Health System, Danville, Pennsylvania
| | - Edward Liu
- Geisinger Commonwealth School of Medicine (E.L.), Danville, Pennsylvania
| | - Heath Mackley
- Department of Radiation Oncology (H.M.), Geisinger Medical Center, Danville, Pennsylvania
| | - Rajiv Panikkar
- Knapper Cancer Center, Geisinger Medical Center (R.P.), Danville, Pennsylvania
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21
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Taniguchi Y, Tamiya A, Matsuda Y, Adachi Y, Enomoto T, Azuma K, Kouno S, Tokoro A, Atagi S. Opioids impair nivolumab outcomes: a retrospective propensity score analysis in non-small-cell lung cancer. BMJ Support Palliat Care 2023; 13:e185-e189. [PMID: 33293293 DOI: 10.1136/bmjspcare-2020-002480] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Opioids are often administered for cancer-related pain relief. However, few reports have evaluated the association between opioids and immune checkpoint inhibitor treatment for patients with non-small-cell lung cancer (NSCLC). The aim of this retrospective study was to reveal the effect of opioids on the prognosis of patients harbouring NSCLC treated with nivolumab. METHODS The medical records of consecutive patients with NSCLC receiving nivolumab at our institution were retrospectively reviewed. We collected clinical data at the time of nivolumab treatment initiation. Propensity score matching (PSM) was performed to minimise potential selection bias. We compared clinical outcomes with and without baseline opioid use. RESULTS Of the 296 patients identified in the study, after PSM, 38 cases with opioid use and matched 38 cases without opioid use were selected. The overall response rate was significantly lower in patients with opioid use than in those without (2.63%, 95% CI 0.47% to 13.49%, vs 21.05%, 95% CI 11.07% to 36.35%; p=0.0284). The median progression-free survival in patients with opioid use was significantly shorter than that in patients without (1.17, 95% CI 0.93 to 1.73 months, vs 2.07 95% CI 1.23 to 4.73 months; p=0.002). The median overall survival in patients with opioid use was significantly shorter than that in patients without (4.20, 95% CI 2.53 to 6.20 months, vs 9.57, 95% CI 2.23 to not reached months; p=0.018). CONCLUSIONS Patients with NSCLC receiving regular opioid administration at nivolumab treatment initiation had a worse nivolumab treatment outcome than patients without opioid use.
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Affiliation(s)
| | - Akihiro Tamiya
- Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Yoshinobu Matsuda
- Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Yuichi Adachi
- Respiratory Medicine and Clinical Immunology, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
| | - Takatoshi Enomoto
- Respiratory Medicine and Clinical Immunology, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
| | - Kouji Azuma
- Respiratory Medicine, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Japan
| | - Shunichi Kouno
- Respiratory Medicine, Gunma University Graduate School of Medicine School of Medicine, Maebashi, Japan
| | - Akihiro Tokoro
- Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Shinji Atagi
- Clinical Research Center, Kinki-Chuo Chest Medical Center, Sakai, Japan
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22
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Bocchi MB, Meschini C, Pietramala S, Perna A, Oliva MS, Matrangolo MR, Ziranu A, Maccauro G, Vitiello R. Electrochemotherapy in the Treatment of Bone Metastases: A Systematic Review. J Clin Med 2023; 12:6150. [PMID: 37834793 PMCID: PMC10573742 DOI: 10.3390/jcm12196150] [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: 06/18/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND AIM Cancers are one of the most frequent causes of death and disability in humans. Skeletal involvement has a major impact on the quality of life and prognosis of cancer patients. Electrochemotherapy is a palliative and minimally invasive oncologic treatment that was first used to treat subcutaneous nodules for malignant tumors. The aim of our review is to evaluate the results of electrochemotherapy in the treatment of bone metastases. METHODS A systematic review of the literature indexed in the PubMed MEDLINE and Cochrane Library databases using the search key words "electrochemotherapy" AND ("metastasis" OR "metastases") was performed. The Preferred Reporting Items for Systematic Reviews and MetaAnalyses was followed. Inclusion criteria were proven involvement of the appendicular skeleton in metastatic carcinoma or melanoma, through at least one percutaneous electrochemotherapy session on the metastatic bone lesion. The exclusion criterion was no skeletal metastatic involvement. RESULTS Eight articles were finally included. We reached a population of 246 patients. The mean age and follow up were 60.1 years old and 11.4 months, respectively. The most represented primary tumor was breast cancer (18.9%). A total of 250 bone lesions were treated with electrochemotherapy. According to RECIST criteria, in our population we observed 55.5% stable diseases. The mean pre-electrochemotherapy VAS value was 6.9, which lowered to 2.7 after treatment. Adverse events occurred in 3.4% of patients. CONCLUSIONS Electrochemotherapy as a minimally invasive and tissue-sparing treatment should be considered for patients with no other alternative to obtain tumor control and improvement in quality of life.
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Affiliation(s)
- Maria Beatrice Bocchi
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cesare Meschini
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Silvia Pietramala
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Perna
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Serena Oliva
- Departement of Orthopaedics, Ospedale San Giovanni Evangelista, 00019 Tivoli, Italy
| | - Maria Rosaria Matrangolo
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonio Ziranu
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulio Maccauro
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Raffaele Vitiello
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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23
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Gueiderikh A, Ung M, Lazarovici J, Danu A, Ghez D, Saleh K, Dragani M, Noël N, Bigenwald C, Willekens C, Ribrag V, Michot JM, Martin V. Incidence, characteristics, management and outcome of patients with follicular lymphoma with tumor epidural compression, a study on 22 cases. Cancer Radiother 2023; 27:370-375. [PMID: 37156711 DOI: 10.1016/j.canrad.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/30/2023] [Accepted: 04/15/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Follicular lymphoma (FL) is one of the most common lymphoma. Occasionally, FL is associated with tumoral epidural compression and management of these patients remain poorly codified. This study aims to report incidence, clinical characteristics, management and outcomes of patients with FL and tumoral epidural compression. MATERIAL AND METHODS Observational, retrospective cohort study of adult patients with FL and epidural tumor compression, treated in a French Institute over the last 20 years (2000-2021). RESULTS Between 2000 and 2021, 1382 patients with FL were followed by the haematological department. Of them, 22 (1.6%) patients (16 men and 6 women) had follicular lymphoma with epidural tumor compression. At epidural tumor compression occurrence, 8/22 (36%) patients had a neurological clinical deficit (motor, sensory or sphincter function) and 14/22 (64%) had tumor pain. All patients were treated with immuno-chemotherapy; the main regimen being used was R-CHOP plus high dose IV methotrexate in 16/22 (73%) patients. Radiotherapy for tumor epidural compression was performed in 19/22 (86%) patients. With a median follow-up of 60 months (range=[1-216]), 5 year local tumor relapse free survival was achieved in 65% (95% CI 47-90%) of patients. The median PFS was of 36 months (95% CI 24-NA) and 5 years OS estimate was 79% (95% CI 62-100%). Two patients developed a relapse at a second epidural site. CONCLUSION FL with tumoral epidural compression reached 1.6% of all FL patients. Management based on immuno-chemotherapy with radiotherapy appeared to produce comparable outcomes with the general FL population.
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Affiliation(s)
- A Gueiderikh
- Radiation therapy department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - M Ung
- Radiation therapy department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - J Lazarovici
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - A Danu
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - D Ghez
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - K Saleh
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - M Dragani
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - N Noël
- Internal medicine department, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - C Bigenwald
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - C Willekens
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - V Ribrag
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - J-M Michot
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - V Martin
- Radiation therapy department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
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24
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Singh N, McClure EM, Akaike T, Park SY, Huynh ET, Goff PH, Nghiem P. The Evolving Treatment Landscape of Merkel Cell Carcinoma. Curr Treat Options Oncol 2023; 24:1231-1258. [PMID: 37403007 PMCID: PMC11260505 DOI: 10.1007/s11864-023-01118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/06/2023]
Abstract
OPINION STATEMENT Merkel cell carcinoma (MCC) has a high risk of recurrence and requires unique treatment relative to other skin cancers. The patient population is generally older, with comorbidities. Multidisciplinary and personalized care is therefore paramount, based on patient preferences regarding risks and benefits. Positron emission tomography and computed tomography (PET-CT) is the most sensitive staging modality and reveals clinically occult disease in ~ 16% of patients. Discovery of occult disease spread markedly alters management. Newly diagnosed, localized disease is often managed with sentinel lymph node biopsy (SLNB), local excision, primary wound closure, and post-operative radiation therapy (PORT). In contrast, metastatic disease is usually treated systemically with an immune checkpoint inhibitor (ICI). However, one or more of these approaches may not be indicated. Criteria for such exceptions and alternative approaches will be discussed. Because MCC recurs in 40% of patients and early detection/treatment of advanced disease is advantageous, close surveillance is recommended. Given that over 90% of initial recurrences arise within 3 years, surveillance frequency can be rapidly decreased after this high-risk period. Patient-specific assessment of risk is important because recurrence risk varies widely (15 to > 80%: Merkelcell.org/recur) depending on baseline patient characteristics and time since treatment. Blood-based surveillance tests are now available (Merkel cell polyomavirus (MCPyV) antibodies and circulating tumor DNA (ctDNA)) with excellent sensitivity that can spare patients from contrast dye, radioactivity, and travel to a cancer imaging facility. If recurrent disease is locoregional, management with surgery and/or RT is typically indicated. ICIs are now the first line for systemic/advanced MCC, with objective response rates (ORRs) exceeding 50%. Cytotoxic chemotherapy is sometimes used for debulking disease or in patients who cannot tolerate ICI. ICI-refractory disease is the major problem faced by this field. Fortunately, numerous promising therapies are on the horizon to address this clinical need.
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Affiliation(s)
- Neha Singh
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Erin M McClure
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Tomoko Akaike
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA
| | - Song Y Park
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA
| | - Emily T Huynh
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA
| | - Peter H Goff
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Paul Nghiem
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA.
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Lin VQ, Riviere P, Murphy JD, Bruggeman AR. Retrospective Review of Follow-up Strategies for Patients Receiving Palliative Radiotherapy. J Pain Symptom Manage 2023; 66:238-241. [PMID: 37302534 DOI: 10.1016/j.jpainsymman.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/17/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
CONTEXT There is no current standard-of-care follow-up strategy for patients who receive palliative radiotherapy (PRT) for bone metastases. Within our institution there is currently a heterogenous practice in which some providers schedule routine follow up 1-3 months after initial PRT while others do follow up only as needed (PRN). OBJECTIVES Our study aims to compare rates of retreatment based on follow-up strategies (planned vs. PRN), explore factors that potentially affect retreatment, and evaluate whether provider follow-up strategy correlates with measurable differences in quality of care. METHODS In a retrospective chart review, PRT courses for bone metastases at our single institution were divided by follow-up strategies (planned vs. PRN). Demographic, clinical, and PRT data were collected and analyzed via descriptive statistics. The relationship between planned follow-up appointment and subsequent retreatment was studied. RESULTS More patients received retreatment within one year of initial PRT in the planned follow-up group than in the PRN follow-up group (40.4% vs. 14.4%, p<0.001). Retreatment was achieved sooner in the planned follow-up group than in the PRN follow-up group (137 days vs. 156 days). When accounting for other variables, having a planned follow-up appointment remains the most important factor in establishing retreatment (OR = 3.32, 2.11-5.29, p<0.001). CONCLUSION Having a planned follow-up appointment after the initial course of PRT improves identification of patients who would benefit from additional treatment, thus improving patient experience and quality of care.
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Affiliation(s)
- Veronica Q Lin
- University of California San Diego, School of Medicine, La Jolla, California, USA
| | - Paul Riviere
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
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Damante MA, Gibbs D, Dibs K, Palmer JD, Raval R, Scharschmidt T, Chakravarti A, Bourekas E, Boulter D, Thomas E, Grecula J, Beyer S, Xu D, Nimjee S, Youssef P, Lonser R, Blakaj DM, Elder JB. Neoadjuvant Arterial Embolization of Spine Metastases Associated With Improved Local Control in Patients Receiving Surgical Decompression and Stereotactic Body Radiotherapy. Neurosurgery 2023; 93:320-329. [PMID: 36861971 DOI: 10.1227/neu.0000000000002411] [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: 09/23/2022] [Accepted: 12/16/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Spine metastases often cause significant pain, instability, and/or neurological morbidity. Local control (LC) of spine metastases has been augmented with advances in systemic therapies, radiation, and surgical technique. Prior reports suggest an association between preoperative arterial embolization and improved LC and palliative pain control. OBJECTIVE To further elucidate the role of neoadjuvant embolization on LC of spine metastases and the potential for improved pain control in patients receiving surgery and stereotactic body radiotherapy (SBRT). METHOD A retrospective single-center review between 2012 and 2020 identified 117 patients with spinal metastases from various solid tumor malignancies managed with surgery and adjuvant SBRT with or without preoperative spinal arterial embolization. Demographic information, radiographic studies, treatment characteristics, Karnofsky Performance Score, Defensive Veterans Pain Rating Scale, and mean daily doses of analgesic medications were reviewed. LC was assessed using magnetic resonance imaging obtained at a median 3-month interval and defined as progression at the surgically treated vertebral level. RESULTS Of 117 patients, 47 (40.2%) underwent preoperative embolization, followed by surgery and SBRT and 70 (59.8%) underwent surgery and SBRT alone. Within the embolization cohort, the median LC was 14.2 months compared with 6.3 months among the nonembolization cohort ( P = .0434). Receiver operating characteristic analysis suggests ≥82.5% embolization predicted significantly improved LC (area under the curve = 0.808; P < .0001). Defensive Veterans Pain Rating Scale mean and maximum scores significantly decreased immediately after embolization ( P < .001). CONCLUSION Preoperative embolization was associated with improved LC and pain control suggesting a novel role for its use. Additional prospective study is warranted.
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Affiliation(s)
- Mark A Damante
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David Gibbs
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Khaled Dibs
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Raju Raval
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas Scharschmidt
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arnab Chakravarti
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Eric Bourekas
- Division of Neuroradiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel Boulter
- Division of Neuroradiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Evan Thomas
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sasha Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David Xu
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Shahid Nimjee
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Patrick Youssef
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Russell Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dukagjin M Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - J Bradley Elder
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Arsenijević T, Stepanović A, Milošević‐Maračić B, Poparić‐Bandjur B, Mišković I, Gavrilović D, Nikitović M. What did COVID-19 pandemics teach us about single-fraction radiotherapy for painful bone metastases-State of the art or undertreatment? Cancer Med 2023; 12:15912-15921. [PMID: 37317639 PMCID: PMC10469708 DOI: 10.1002/cam4.6231] [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: 01/30/2023] [Revised: 04/25/2023] [Accepted: 06/01/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Choosing the optimal treatment approach for patients with painful bone metastases during the COVID-19 pandemic became challenging. A simple technique, single fraction radiotherapy was recommended for these patients usually referring to bone metastases as a single entity, although it is a very heterogeneous group of patients. AIM This study aimed to analyze the response to palliative single fraction radiotherapy in relation to age, performance status, primary tumor, histopathology, and bone localization in the group of patients with painful bone metastases. METHODS A clinical, prospective, non-randomized study was conducted at the Institute for Oncology and Radiology of Serbia, which included 64 patients with noncomplicated, painful bone metastases who underwent palliative, pain-relieving radiation therapy with a single tumor dose of 8Gy in a single hospital visit. Response to treatment was patient reported via telephone interview using visual analog scale. The response assessment was based on the international consensus panel of radiation oncologists. RESULTS In the entire group of patients, 83% responded to radiotherapy. No statistically significant difference was observed in response to therapy, time to reach the maximum response, degree of pain reduction, nor in response duration depending on the patient's age, performance status, the primary origin of the tumor, histopathology, or location of the metastasis (bone) that was irradiated. CONCLUSION Regardless of clinical parameters, palliative radiotherapy with a single dose of 8Gy can be considered very effective in quick pain relief in patients with noncomplicated painful bone metastases. Single fraction radiotherapy in a single hospital visit, as well as patient-reported outcome for these patients may be considered favorable beyond Covid pandemics.
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Affiliation(s)
- Tatjana Arsenijević
- University of Belgrade, Faculty of MedicineBelgradeSerbia
- Institute for Oncology and Radiology of SerbiaBelgradeSerbia
| | - Aleksandar Stepanović
- University of Belgrade, Faculty of MedicineBelgradeSerbia
- Institute for Oncology and Radiology of SerbiaBelgradeSerbia
| | | | | | - Ivana Mišković
- Institute for Oncology and Radiology of SerbiaBelgradeSerbia
| | | | - Marina Nikitović
- University of Belgrade, Faculty of MedicineBelgradeSerbia
- Institute for Oncology and Radiology of SerbiaBelgradeSerbia
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Tanaka O, Taniguchi T, Nakaya S, Adachi K, Kiryu T, Makita C, Matsuo M. Stereotactic body radiation therapy to the spine: contouring the cauda equina instead of the spinal cord is more practical as the organ at risk. Rep Pract Oncol Radiother 2023; 28:407-415. [PMID: 37795406 PMCID: PMC10547411 DOI: 10.5603/rpor.a2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/05/2023] [Indexed: 10/06/2023] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) is recognized as a curative treatment for oligometastasis. The spinal cord becomes the cauda equina at the lumbar level, and the nerves are located dorsally. Recently, a consensus has been reached that the cauda equina should be contoured as an organ at risk (OAR). Here, we examined the separate contouring benefits for the spinal canal versus the cauda equina only as the OAR. Materials and methods A medical physicist designed a simulation plan for 10 patients with isolated lumbar metastasis. The OAR was set with three contours: the whole spinal canal, cauda equina only, and cauda equina with bilateral nerve roots. The prescribed dose for the planning target volume (PTV) was 30 Gy/3 fx. Results For the constrained QAR doses, D90 and D95 were statistically significant due to the different OAR contouring. The maximum dose (Dmax) was increased to the spinal canal when the cauda equina max was set to ≤ 20 Gy, but dose hotspots were observed in most cases in the medullary area. The Dmax and PTV coverage were negatively correlated for the cauda equina and the spinal canal if Dmax was set to ≤ 20 Gy for both. Conclusions A portion of the spinal fluid is also included when the spinal canal is set as the OAR. Thus, the PTV coverage rate will be poor if the tumor is in contact with the spinal canal. However, the PTV coverage rate increases if only the cauda equina is set as the OAR.
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Affiliation(s)
- Osamu Tanaka
- Department of Radiation Oncology, Asahi University Hospital, Gifu City, Gifu, Japan
| | - Takuya Taniguchi
- Department of Radiation Oncology, Asahi University Hospital, Gifu City, Gifu, Japan
| | - Shuto Nakaya
- Department of Radiation Oncology, Asahi University Hospital, Gifu City, Gifu, Japan
| | - Kousei Adachi
- Department of Radiation Oncology, Asahi University Hospital, Gifu City, Gifu, Japan
| | - Takuji Kiryu
- Department of Radiation Oncology, Asahi University Hospital, Gifu City, Gifu, Japan
| | - Chiyoko Makita
- Department of Radiology, Gifu University Hospital, Gifu City, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Hospital, Gifu City, Gifu, Japan
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Ozer M, Goksu SY, Lin RY, Ayasun R, Kahramangil D, Rogers SC, Fabregas JC, Ramnaraign BH, George TJ, Feely M, Cabrera R, Duarte S, Zarrinpar A, Sahin I. Effects of Clinical and Tumor Characteristics on Survival in Patients with Hepatocellular Carcinoma with Bone Metastasis. J Hepatocell Carcinoma 2023; 10:1129-1141. [PMID: 37489126 PMCID: PMC10363394 DOI: 10.2147/jhc.s417273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
Background Advanced hepatocellular carcinoma (HCC) generally has a dismal prognosis. Bone metastases from HCC are infrequent, with a poorer prognosis. However, the survival influencing factors are not yet well understood. Aim The aim of the present study was to assess the clinical features and tumor characteristics of HCC patients with bone metastasis. Methods A cohort of 170,576 adult patients with HCC was studied using the National Cancer Database (NCDB) spanning from 2010 to 2019, and within this group, 5285 patients (3.1%) were diagnosed with bone metastasis. We performed the Kaplan-Meier method to calculate the median overall survival (OS). We included demographics (age at diagnosis, gender, race, insurance status), comorbidity score, and treatment characteristics. Results Of a total of 5285 HCC patients with bone metastasis, 86.2% were male and 61.2% were non-Hispanic white. Most patients (55.1%) were below 65, and 89% had a total Charlson-Deyo comorbidity score of under 3. Among patients with known tumor grade, 24.8% had well-differentiated tumors, and 36.1% had poorly differentiated tumors. Chemotherapy was administrated to 39.5% of patients. In univariate analysis, patients with well-differentiated tumors had better OS compared to poorly differentiated tumors (5.4 months vs 3.0 months, p = 0.001). Patients who received single or multiagent chemotherapy were significantly associated with improved OS compared to patients who did not receive chemotherapy (7.0 and 8.5 months vs 1.94 months, respectively). We also found mortality difference between age, comorbidity scores, facility types and race groups. Conclusion In this cohort analysis of NCDB data, we found better OS in treatment receipt, lower tumor grade, younger age, non-Hispanic Black and Hispanic race, treatment at academic facility and lower comorbidity score in HCC patients with bone metastasis. The study results may have a consequential impact on the treatment decisions for HCC patients with bone metastasis.
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Affiliation(s)
- Muhammet Ozer
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Suleyman Yasin Goksu
- Division of Hematology/Oncology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rick Y Lin
- Department of Medicine, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Ruveyda Ayasun
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, USA
| | - Doga Kahramangil
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Sherise C Rogers
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
- University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Jesus C Fabregas
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
- University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Brian H Ramnaraign
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
- University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Thomas J George
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
- University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Michael Feely
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Roniel Cabrera
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA
| | - Sergio Duarte
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ali Zarrinpar
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ilyas Sahin
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
- University of Florida Health Cancer Center, Gainesville, FL, USA
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Reginelli A, Patanè V, Urraro F, Russo A, De Chiara M, Clemente A, Atripaldi U, Balestrucci G, Buono M, D'ippolito E, Grassi R, D'onofrio I, Napolitano S, Troiani T, De Vita F, Ciardiello F, Nardone V, Cappabianca S. Magnetic Resonance Imaging Evaluation of Bone Metastases Treated with Radiotherapy in Palliative Intent: A Multicenter Prospective Study on Clinical and Instrumental Evaluation Assessment Concordance (MARTE Study). Diagnostics (Basel) 2023; 13:2334. [PMID: 37510078 PMCID: PMC10378594 DOI: 10.3390/diagnostics13142334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
Metastasis to bone is a common occurrence among epithelial tumors, with a high incidence rate in the Western world. As a result, bone lesions are a significant burden on the healthcare system, with a high morbidity index. These injuries are often symptomatic and can lead to functional limitations, which in turn cause reduced mobility in patients. Additionally, they can lead to secondary complications such as pathological fractures, spinal cord compression, hypercalcemia, or bone marrow suppression. The treatment of bone metastases requires collaboration between multiple healthcare professionals, including oncologists, orthopedists, neurosurgeons, physiatrists, and radiotherapists. The primary objective of this study is to evaluate the correlation between two methods used to assess local control. Specifically, the study aims to determine if a reduction in the volume of bone lesions corresponds to better symptomatic control in the clinical management of patients, and vice versa. To achieve this objective, the study evaluates morphological criteria by comparing pre- and post-radiotherapy treatment imaging using MRI and RECIST 1.1 criteria. MRI without contrast is the preferred diagnostic imaging method, due to its excellent tolerance by patients, the absence of exposure to ionizing radiation, and the avoidance of paramagnetic contrast media side effects. This imaging modality allows for accurate assessment of bone lesions. One of the secondary objectives of this study is to identify potentially useful parameters that can distinguish patients into two classes: "good" and "poor" responders to treatment, as reported by previous studies in the literature. These parameters can be evaluated from the imaging examinations by analyzing morphological changes and radiomic features on different sequences, such as T1, STIR (short tau inversion recovery), and DWI-MRI (diffusion-weighted).
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Vittorio Patanè
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Anna Russo
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Marco De Chiara
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Alfredo Clemente
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Umberto Atripaldi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Giovanni Balestrucci
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Mauro Buono
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Emma D'ippolito
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Ida D'onofrio
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Stefania Napolitano
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Teresa Troiani
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Ferdinando De Vita
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Fortunato Ciardiello
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Valerio Nardone
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
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Liu W, Qiao X, Ge H, Zhang S, Sun X, Li J, Chen W, Gu W, Yuan S. Recurrence patterns are significantly associated with the 18F‑FDG PET/CT radiomic features of patients with locally advanced non‑small cell lung cancer treated with chemoradiotherapy. Oncol Lett 2023; 26:317. [PMID: 37332327 PMCID: PMC10272971 DOI: 10.3892/ol.2023.13903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
A model for predicting the recurrence pattern of patients with locally advanced non-small cell lung cancer (LA-NSCLC) treated with chemoradiotherapy is of great importance for precision treatment. The present study analyzed whether the comprehensive quantitative values (CVs) of the fluorine-18(18F)-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) radiomic features and metastasis tumor volume (MTV) combined with clinical characteristics could predict the recurrence pattern of patients with LA-NSCLC treated with chemoradiotherapy. Patients with LA-NSCLC treated with chemoradiotherapy were divided into training and validation sets. The recurrence profile of each patient, including locoregional recurrence (LR), distant metastasis (DM) and both LR/DM were recorded. In the training set of patients, the primary tumor prior radiotherapy with 18F-FDG PET/CT and both primary tumors and lymph node metastasis were considered as the regions of interest (ROIs). The CVs of ROIs were calculated using principal component analysis. Additionally, MTVs were obtained from ROIs. The CVs, MTVs and the clinical characteristics of patients were subjected to aforementioned analysis. Furthermore, for the validation set of patients, the CVs and clinical characteristics of patients with LA-NSCLC were also subjected to logistic regression analysis and the area under the curve (AUC) values calculated. A total of 86 patients with LA-NSCLC were included in the analysis, including 59 and 27 patients in the training and validation sets of patients, respectively. The analysis revealed 22 and 12 cases with LR, 24 and 6 cases with DM and 13 and 9 cases with LR/DM in the training and validation sets of patients, respectively. Histological subtype, CV2-5 and CV3-4 were identified as independent variables in the logistic regression analysis (P<0.05). In addition, the AUC values for diagnosing LR, DM and LR/DM were 0.873, 0.711 and 0.826, and 0.675, 0.772 and 0.708 in the training and validation sets of patients, respectively. Overall, the results demonstrated that the spatial and metabolic heterogeneity quantitative values from the primary tumor combined with the histological subtype could predict the recurrence pattern of patients with LA-NSCLC treated with chemoradiotherapy.
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Affiliation(s)
- Wenju Liu
- Department of Radiation Oncology, Shandong University Cancer Center, Jinan, Shandong 250117, P.R. China
- Department of Radiation Oncology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Xu Qiao
- School of Control Science and Engineering, Shandong University, Jinan, Shandong 250117, P.R. China
| | - Hong Ge
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan 450000, P.R. China
| | - Sheng Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Xiaojiang Sun
- Department of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Jiancheng Li
- Department of Radiation Oncology, Fujian Cancer Hospital, College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Weilin Chen
- Department of Radiation Oncology, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, Fujian 363000, P.R. China
| | - Wendong Gu
- Department of Radiation Oncology, The Third Hospital Afiliated to Suzhou University, Changzhou, Jiangsu 213000, P.R. China
| | - Shuanghu Yuan
- Department of Radiation Oncology, Shandong University Cancer Center, Jinan, Shandong 250117, P.R. China
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan 450000, P.R. China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
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32
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Hyung Kim T, Kim J, Lee J, Nam TK, Min Choi Y, Seong J. Vertebral compression fracture after stereotactic ablative radiotherapy in patients with oligometastatic bone lesions from hepatocellular carcinoma. Clin Transl Radiat Oncol 2023; 41:100636. [PMID: 37216046 PMCID: PMC10195846 DOI: 10.1016/j.ctro.2023.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/24/2023] Open
Abstract
Background and purpose Stereotactic ablative radiotherapy (SABR) is popularly used to treat bone metastasis. Despite its efficacy, adverse events, including vertebral compression fracture (VCF), are frequently observed. Here, we investigated VCF risk after SABR for oligometastatic vertebral bone metastasis from hepatocellular carcinoma. Materials and methods A total of 84 patients with 144 metastatic bone lesions treated at three institutions between 2009 and 2019 were retrospectively reviewed. The primary endpoint was VCF development, either new or progression of a pre-existing VCF. VCFs were assessed using the spinal instability neoplastic score (SINS). Results Among 144 spinal segments, 26 (18%) had pre-existing VCF and 90 (63%) had soft tissue extension. The median biologically effective dose (BED) was 76.8 Gy. VCF developed in 14 (12%) of 118 VCF-naïve patients and progressed in 20 of the 26 with pre-existing VCF. The median time to VCF development was 6 months (range, 1-12 months). The cumulative incidence of VCF at 12 months with SINS class I, II and III was 0%, 26% and 83%, respectively (p < 0.001). Significant factors for VCF development were pre-existing VCF, soft tissue extension, high BED, and SINS class in univariate analysis, and pre-existing VCF in multivariate analysis. Of the six components of SINS, pain, type of bone lesion, spine alignment, vertebral body collapse, and posterolateral involvement were identified as predictors of VCF development. Conclusion SABR for oligometastatic vertebral bone lesions from HCC resulted in a substantial rate of new VCF development and pre-existing VCF progression. Pre-existing VCF was significant risk factor for VCF development, which require special attention in patient care. Patients with SINS class III should be considered surgical treatment rather than upfront SABR.
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Affiliation(s)
- Tae Hyung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Jina Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Joongyo Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Taek-Keun Nam
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Min Choi
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, South Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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Tseng YD. Radiation Therapy for Painful Bone Metastases: Fractionation, Recalcification, and Symptom Control. Semin Radiat Oncol 2023; 33:139-147. [PMID: 36990631 DOI: 10.1016/j.semradonc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Bone is a common site for metastases, which may cause pain and other skeletal-related events (SRE) in patients with advanced cancer. Since the 1980s, prospective clinical trials have demonstrated the high efficacy of external beam radiotherapy (EBRT) for pain relief from focal, symptomatic lesions. In uncomplicated bone metastases, which include those without pathologic fracture, evidence of cord compression, or prior surgical intervention, improvement or complete pain relief with radiotherapy is as high as 60%, with no difference in efficacy when radiotherapy is delivered in a single or multiple fractions. The ability to treat with a single fraction makes EBRT an attractive therapy even for patients with poor performance status and/or life expectancy. Even in patients with complicated bone metastases (eg cord compression), several randomized trials have demonstrated similar rates of pain relief in addition to improved functional outcomes such as ambulation. In this review, we summarize the role of EBRT for alleviating painful bone metastases and explore its role for other endpoints including functional outcomes, recalcification, and prevention of SREs.
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Affiliation(s)
- Yolanda D Tseng
- Department of Radiation Oncology, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA.
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Cevolani L, Campanacci L, Staals EL, Dozza B, Bianchi G, De Terlizzi F, Donati DM. Is the association of electrochemotherapy and bone fixation rational in patients with bone metastasis? J Surg Oncol 2023. [PMID: 36966436 DOI: 10.1002/jso.27247] [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: 01/19/2023] [Revised: 02/19/2023] [Accepted: 03/07/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Bone metastases are frequent in patients with cancer. Electrochemotherapy (ECT) is a minimally invasive treatment based on a high-voltage electric pulse combined with an anticancer drug. Preclinical and clinical studies supported the use of ECT in patients with metastatic bone disease, demonstrating that it does not damage the mineral structure of the bone and its regenerative capacity, and that is feasible and efficient for the treatment of bone metastases. Year 2014 saw the start of a registry of patients with bone metastases treated with ECT, whose data are recorded in a shared database. QUESTIONS/PURPOSES (1) Among patients who underwent ECT and internal fixation for bone metastasis, how many experienced a reduction of pain? (2) How many cases showed a radiological response? (3) How many patients presented local or systemic complication after ECT and fixation? PATIENTS AND METHODS Patients were treated in Bologna at Rizzoli Orthopaedic Institute between March 2014 and February 2022 and recorded in the REINBONE registry (a shared database protected by security passwords): clinical and radiological information, ECT session, adverse events, response, quality of life indicators, and duration of follow-up were registered. We consider only cases treated with ECT and intramedullary nail during the same surgical session. Patients included in the analysis were 32: 15 males and 17 females, mean age 65 ± 13 years (median 66, range 38-88 years), mean time since diagnosis of primary tumor 6.2 ± 7.0 years (median 2.9, range 0-22 years). Nail was indicated in 13 cases for a pathological fracture in, 19 for an impending fracture. Follow-up was available for 29 patients, as 2 patients were lost to follow-up and 1 was unable to return to controls. Mean follow-up time was 7.7 ± 6.5 months (median 5, range 1-24), and 16 patients (50%) had a follow-up longer than 6 months. RESULTS A significant decrease in pain intensity was observed at the mean Visual Numeric Scale after treatment. Bone recovery was observed in 13 patients. The other 16 patients remained without changes, and one presented disease progression. One patient presented a fracture occurrence during the ECT procedure. Among all patients, bone recovery was observed in 13 patients: complete recovery in 1 patient (3%) and partial recovery in 12 patients (41%). The other 16 patients remained without changes, and one presented disease progression. One patient presented a fracture occurrence during the ECT procedure. However, healing was possible with normal fracture callus quality and healing time. No other local or systemic complications were observed. CONCLUSION We found that pain levels decreased after treatment in 23 of the 29 cases for a pain relief rate of 79% at final follow-up. Pain is one of the most important indicators of quality of life in patients that undergo palliative treatments. Even if conventional external body radiotherapy is considered a noninvasive treatment, it presents a dose-dependent toxicity. ECT provides a chemical necrosis preserving osteogenic activity and structural integrity of bone trabeculae; this is a crucial difference with other local treatments and allows bone healing in case of pathological fracture. The risk of local progression in our patient population was small, and 44% experienced bone recovery while 53% of the cases remained unchanged. We observe intraoperative fracture in one case. This technique, in selected patients, improves outcome in bone metastatic patients combing both the efficacy of the ECT in the local control of the disease and the mechanical stability with the bone fixation to synergize their benefits. Moreover, the risk of complication is very low. Although encouraging data, comparative studies are required to quantify the real efficacy of the technique. Level of Evidence Level I, therapeutic study.
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Affiliation(s)
- Luca Cevolani
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Laura Campanacci
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric Lodewijk Staals
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Barbara Dozza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giuseppe Bianchi
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Davide Maria Donati
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Song X, Wei J, Sun R, Jiang W, Chen Y, Shao Y, Gu W. Stereotactic Body Radiation Therapy Versus Conventional Radiation Therapy in Pain Relief for Bone Metastases: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2023; 115:909-921. [PMID: 36273520 DOI: 10.1016/j.ijrobp.2022.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/15/2022] [Accepted: 10/08/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE This study aimed to investigate the difference in pain relief between stereotactic body radiation therapy (SBRT) and conventional radiation therapy (cRT) for patients with bone metastases. METHODS AND MATERIALS Clinical trials and observational studies comparing SBRT versus cRT for bone metastases were retrieved. The main endpoint was pain relief after radiation therapy; the secondary endpoints were pain score change, local progression-free survival, reirradiation rate, and toxic events. When there was a significant heterogeneity, the random-effects model was applied. Otherwise, the fixed-effects model was used. Analyses of all included studies were performed first, followed by analyses of randomized controlled trials (RCTs) only. RESULTS Six RCTs, 1 prospective cohort study, and 3 retrospective observational studies were enrolled. Between 2004 and 2019, 448 patients received SBRT, and 445 patients received cRT. All prospective studies defined the lesions as oligometastatic. Pooled results based on all included studies indicated that SBRT was generally associated with a higher overall relief rate (P < .001 at 3 months; P = .015 at 6 months) and complete relief rate (P = .029 at 1 month; P < .001 at 6 months). Pooled results based on RCTs indicated that at 3 and 6 months, SBRT was associated with a higher overall relief rate (P < .001 and P = .017, respectively) and complete relief rate (P < .001 and P < .00, respectively). Subgroup analyses indicated that in more cases, the analgesic advantage of SBRT was more obvious when spinal lesions were irradiated, when the difference in the mean biological effective dose (BED) was less, or when intensity modulated radiation therapy was used to deliver SBRT. CONCLUSIONS Excessive elevation of BED introduces the risk of diminishing the analgesic effect of SBRT. SBRT delivered using intensity modulated radiation therapy is preferred for pain relief in spinal oligometastases. More RCTs are required to determine the most appropriate BED or dose regimen for SBRT.
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Affiliation(s)
- Xing Song
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Jiangsu, China
| | - Jun Wei
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Jiangsu, China
| | - Rui Sun
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Jiangsu, China
| | - Wenjie Jiang
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Jiangsu, China
| | - Yuan Chen
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Jiangsu, China
| | - Yingjie Shao
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Jiangsu, China.
| | - Wendong Gu
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Jiangsu, China.
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Predictive model based on DCE-MRI and clinical features for the evaluation of pain response after stereotactic body radiotherapy in patients with spinal metastases. Eur Radiol 2023:10.1007/s00330-023-09437-y. [PMID: 36735042 DOI: 10.1007/s00330-023-09437-y] [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: 10/03/2022] [Revised: 12/12/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the correlation of conventional MRI, DCE-MRI and clinical features with pain response after stereotactic body radiotherapy (SBRT) in patients with spinal metastases and establish a pain response prediction model. METHODS Patients with spinal metastases who received SBRT in our hospital from July 2018 to April 2022 consecutively were enrolled. All patients underwent conventional MRI and DCE-MRI before treatment. Pain was assessed before treatment and in the third month after treatment, and the patients were divided into pain-response and no-pain-response groups. A multivariate logistic regression model was constructed to obtain the odds ratio and 95% confidence interval (CI) for each variable. C-index was used to evaluate the model's discrimination performance. RESULTS Overall, 112 independent spinal lesions in 89 patients were included. There were 73 (65.2%) and 39 (34.8%) lesions in the pain-response and no-pain-response groups, respectively. Multivariate analysis showed that the number of treated lesions, pretreatment pain score, Karnofsky performance status score, Bilsky grade, and the DCE-MRI quantitative parameter Ktrans were independent predictors of post-SBRT pain response in patients with spinal metastases. The discrimination performance of the prediction model was good; the C index was 0.806 (95% CI: 0.721-0.891), and the corrected C-index was 0.754. CONCLUSION Some imaging and clinical features correlated with post-SBRT pain response in patients with spinal metastases. The model based on these characteristics has a good predictive value and can provide valuable information for clinical decision-making. KEY POINTS • SBRT can accurately irradiate spinal metastases with ablative doses. • Predicting the post-SBRT pain response has important clinical implications. • The prediction models established based on clinical and MRI features have good performance.
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Ong WL, MacManus M, Milne RL, Foroudi F, Millar JL. Large variation in radiation therapy fractionation for multiple myeloma in Australia. Asia Pac J Clin Oncol 2023; 19:149-157. [PMID: 35599450 PMCID: PMC10084224 DOI: 10.1111/ajco.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 01/20/2023]
Abstract
AIM To evaluate the patterns of use of different radiation therapy (RT) fractionation for multiple myeloma (MM) bone disease. METHODS This is a population-based cohort of patients with MM who had RT between 2012 and 2017 as captured in the statewide Victorian Radiotherapy Minimum Data Set in Australia. Data linkage was performed to identify subsets of RT delivered within 3 months of death. RT fractionation was classified into four groups: single-fraction (SFRT), 2-5, 6-10, and > 10 fractions. Changes in RT fractionation use over time were evaluated with the Cochran-Armitage test for trend. Factors associated with RT fractionation were evaluated using multivariate logistic regressions. RESULTS Nine hundred and sixty-seven courses of RT were delivered in 623 patients. The proportion of SFRT, 2-5, 6-10 and > 10 fractions RT was 18%, 47%, 28%, and 7%, respectively. There was an increase in the use of 2-5 fractions, from 48% in 2012 to 60% in 2017 (p-trend < .001), with corresponding decrease in the use of 6-10 fractions, from 26% in 2012 to 20% in 2017 (p-trend = .003). Nine percent (40/430) of RT courses at private institutions were SFRT, compared to 25% (135/537) in public institutions (p < .001). In multivariate analyses, treatment in private institution was the strongest predictor of multifraction RT use. SFRT use was more common closer to the end of life-18%, 14%, and 33% of RT within 2-3, 1-2, < 1 month of death, respectively. CONCLUSION There is increasing use of shorter course RT (2-5 fractions) for MM over time. SFRT use remains low, with large variation in practice.
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Affiliation(s)
- Wee Loon Ong
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Michael MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Jeremy L Millar
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Di Franco R, Pezzulla D, Arcidiacono F, Pontoriero A, Cellini F, Belgioia L, Borzillo V, Lillo S, Pastore F, Dominici L, Longo S, Cacciola A, Ciabattoni A, Zamagni A, Francolini G, Fontana A, Scipilliti E, Mazzola R, D'Angelo E, Ingargiola R, Muto P, Maranzano E. Reirradiation on spine metastases: an Italian survey on behalf of palliative care and reirradiation study groups of Italian association of radiotherapy and clinical oncology (AIRO). CLINICAL & TRANSLATIONAL ONCOLOGY : OFFICIAL PUBLICATION OF THE FEDERATION OF SPANISH ONCOLOGY SOCIETIES AND OF THE NATIONAL CANCER INSTITUTE OF MEXICO 2023; 25:408-416. [PMID: 36163444 DOI: 10.1007/s12094-022-02951-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/07/2022] [Indexed: 01/27/2023]
Abstract
AIM This survey derived from the collaboration between the Palliative Care and Reirradiation Study Groups of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Its aim was to obtain a real "snapshot" on the treatments of spinal metastases, focusing on reirradiation, among radiation oncologists in Italy. METHODS The survey was elaborated on SurveyMonkey's online interface and was sent via e-mail to all Radiation Oncologists of AIRO that were invited to anonymously fill in the electronic form within 60 days. The questionnaire was prepared by the AIRO "Palliative care" and "Reirradiation" Study Groups and it consisted of 36 questions, 19 single-choice questions, 10 multiple-choice questions and 6 open questions. The data were analyzed and represented with tables and graphs. RESULTS The survey shows that palliative radiotherapy remains a field of interest for most ROs in the Italian centers. 3D Conventional Radiation Therapy (3DCRT) alone or in combination with other techniques is the primary choice for patients with a life expectancy of less than 6 months. For patients with a life expectancy of more than six months, there is an increased use of new technologies, such as Volumetric Modulated Arc Therapy (VMAT). Factors considered for retreatment are time between first and second treatment, dose delivered to spine metastasis and spinal cord in the first treatment, vertebral stability, symptoms, and/or performance status. The most feared complication are myelopathy followed by vertebral fracture and local recurrence. This explain an increasing focus on patient selection and the use of high technology in the treatment of metastatic patients. CONCLUSION Stereotactic body radiotherapy (SBRT) and image-guided radiotherapy allow the administration of ablative RT doses while sparing the constraints of healthy tissue in spinal metastases. However, there is still an unclear and heterogeneous reality in the reirradiation of spinal metastases. A national registry with the aim of clarifying the most controversial aspects of vertebral metastasis retreatments will enable better management of these patients and design more targeted study designs.
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Affiliation(s)
- Rossella Di Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy.
| | | | | | - Francesco Cellini
- Dipartimento di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Liliana Belgioia
- Department of Health Science (DISSAL), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valentina Borzillo
- Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Sara Lillo
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - Luca Dominici
- Department of Radiotherapy, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Silvia Longo
- Dipartimento di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | | | | | - Alice Zamagni
- Radiation Oncology, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum-Bologna University, Bologna, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Antonella Fontana
- UOC Radioterapia, Ospedale S.M. Goretti ASL di Latina, Latina, Italy
| | - Esmeralda Scipilliti
- Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Rosario Mazzola
- Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Negrar, Italy
| | - Elisa D'Angelo
- UOC di Radioterapia Oncologica, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Rossana Ingargiola
- Dipartimento di Radioterapia, Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Paolo Muto
- Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Ernesto Maranzano
- University of Perugia-Faculty of Medicine and Surgery, Radiotherapy Oncology Centre-"S. Maria" Hospital, Terni, Italy
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Mizonobe K, Akasaka H, Uehara K, Oki Y, Nakayama M, Tamura S, Munetomo Y, Kubo K, Kawaguchi H, Harada A, Mayahara H. Respiratory motion tracking of spine stereotactic radiotherapy in prone position. J Appl Clin Med Phys 2023; 24:e13910. [PMID: 36650923 PMCID: PMC10161010 DOI: 10.1002/acm2.13910] [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: 07/11/2022] [Revised: 10/18/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The CyberKnife system is a specialized device for non-coplanar irradiation; however, it possesses the geometric restriction that the beam cannot be irradiated from under the treatment couch. Prone positioning is expected to reduce the dose to normal lung tissue in spinal stereotactic body radiotherapy (SBRT) owing to the efficiency of beam arrangement; however, respiratory motion occurs. Therefore, the Xsight spine prone tracking (XSPT) system is used to reduce the effects of respiratory motion. The purpose of this study was to evaluate the motion-tracking error of the spine in the prone position. MATERIALS AND METHODS Data from all 25 patients who underwent spinal SBRT at our institution between April 2020 and February 2022 using CyberKnife (VSI, version 11.1.0) with the XSPT tracking system were retrospectively analyzed using log files. The tumor motion, correlation, and prediction errors for each patient were examined. Furthermore, to assess the potential relationships between the parameters, the relationships between the tumor-motion amplitudes and correlation or prediction errors were investigated using linear regression. RESULTS The tumor-motion amplitudes in each direction were as follows: superior-inferior (SI), 0.51 ± 0.39 mm; left-right (LR), 0.37 ± 0.29 mm; and anterior-posterior (AP), 3.43 ± 1.63 mm. The overall mean correlation and prediction errors were 0.66 ± 0.48 mm and 0.06 ± 0.07 mm, respectively. The prediction errors were strongly correlated with the tumor-motion amplitudes, whereas the correlation errors were not. CONCLUSIONS This study demonstrated that the correlation error of spinal SBRT in the prone position is sufficiently small to be independent of the tumor-motion amplitude. Furthermore, the prediction error is small, contributing only slightly to the tracking error. These findings will improve the understanding of how to compensate for respiratory-motion uncertainty in the prone position.
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Affiliation(s)
- Kazufusa Mizonobe
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroaki Akasaka
- Department of Chemical Engineering, The University of Melbourne, The University of Melbourne Grattan Street, Parkville, Victoria, Australia.,Division of Radiation Oncology, Kobe University Graduate School of Medicine, Chuou-ku, Kobe, Hyogo, Japan
| | - Kazuyuki Uehara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Yuya Oki
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Masao Nakayama
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Chuou-ku, Kobe, Hyogo, Japan.,Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Shuhei Tamura
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Yoshiki Munetomo
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Katsumaro Kubo
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroki Kawaguchi
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Aya Harada
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroshi Mayahara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
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Mushonga M, Abdihamid O, Ntizimira C, Murenzi G, Ka S, Hammad N, Rubagumya F. The first Choosing Wisely Africa conference: a roadmap to value-based cancer care in Africa (16th December 2022, Senegal). Ecancermedicalscience 2023; 17:1517. [PMID: 37113728 PMCID: PMC10129401 DOI: 10.3332/ecancer.2022.1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Indexed: 04/29/2023] Open
Abstract
The Choosing Wisely campaign was formally launched in 2012 and a decade later, the inaugural Choosing Wisely Africa conference was held in Dakar, Senegal on 16 December 2022 supported by ecancer. Academic partners included Ministere de la Sante et de I'Action Sociale, Senegalese Association of Palliative Care, Federation Internationale des Soins Palliatifs, Universite Cheikh Anta diop de Dakar, Societe Senegalaise de Cancerologie and King's College London. There were around 70 delegates attending in person mostly from Senegal and a further 30 joining virtually. Ten speakers gave insight into Choosing Wisely from an African perspective and Dr's Fabio Moraes and Frederic Ivan Ting shared the Choosing Wisely experience from Brazil and the Philippines, respectively. This report therefore shares the highlights of the first Choosing Wisely Africa conference guided by topics discussed.
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Affiliation(s)
- Melinda Mushonga
- Sunnybrook Health Sciences, Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Omar Abdihamid
- The Garissa Cancer Center, Garissa County Referral Hospital, Garissa, Kenya
| | | | - Gad Murenzi
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda) and Rwanda Military Hospital, Kigali, Rwanda
| | - Sidy Ka
- Cheikh Anta Diop University, Dakar 10700, Senegal
| | - Nazik Hammad
- Departments of Oncology, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Fidel Rubagumya
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda) and Rwanda Military Hospital, Kigali, Rwanda
- Department of Oncology and Department of Research, Rwanda Military Hospital, Kigali, Rwanda
- Faculty of Medicine, University of Rwanda, Kigali, Rwanda
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41
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Slotman DJ, Bartels MMTJ, Ferrer CJ, Bos C, Bartels LW, Boomsma MF, Phernambucq ECJ, Nijholt IM, Morganti AG, Siepe G, Buwenge M, Grüll H, Bratke G, Yeo SY, Blanco Sequeiros R, Minn H, Huhtala M, Napoli A, De Felice F, Catalano C, Bazzocchi A, Gasperini C, Campanacci L, Simões Corrêa Galendi J, Müller D, Braat MNGJA, Moonen C, Verkooijen HM. Focused Ultrasound and RadioTHERapy for non-invasive palliative pain treatment in patients with bone metastasis: a study protocol for the three armed randomized controlled FURTHER trial. Trials 2022; 23:1061. [PMID: 36582001 PMCID: PMC9798627 DOI: 10.1186/s13063-022-06942-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/17/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cancer-induced bone pain (CIBP), caused by bone metastases, is a common complication of cancer and strongly impairs quality of life (QoL). External beam radiotherapy (EBRT) is the current standard of care for treatment of CIBP. However, approximately 45% of patients have no adequate pain response after EBRT. Magnetic resonance image-guided high-intensity focused ultrasound (MR-HIFU) may improve pain palliation in this patient population. The main objective of this trial was to compare MR-HIFU, EBRT, and MR-HIFU + EBRT for the palliative treatment of bone metastases. METHODS/DESIGN The FURTHER trial is an international multicenter, three-armed randomized controlled trial. A total of 216 patients with painful bone metastases will be randomized in a 1:1:1 ratio to receive EBRT only, MR-HIFU only, or combined treatment with EBRT followed by MR-HIFU. During a follow-up period of 6 months, patients will be contacted at eight time points to retrieve information about their level of pain, QoL, and the occurrence of (serious) adverse events. The primary outcome of the trial is pain response at 14 days after start of treatment. Secondary outcomes include pain response at 14 days after trial enrolment, pain scores (daily until the 21st day and at 4, 6, 12 and 24 weeks), toxicity, adverse events, QoL, and survival. Cost-effectiveness and cost-utility analysis will be conducted. DISCUSSION The FURTHER trial aims to evaluate the effectiveness and cost-effectiveness of MR-HIFU-alone or in combination with EBRT-compared to EBRT to relieve CIBP. The trial will be performed in six hospitals in four European countries, all of which are partners in the FURTHER consortium. TRIAL REGISTRATION The FURTHER trial is registered under the Netherlands Trials Register number NL71303.041.19 and ClinicalTrials.gov registration number NCT04307914. Date of trial registration is 13-01-2020.
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Affiliation(s)
- Derk J. Slotman
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands ,grid.452600.50000 0001 0547 5927Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Marcia M. T. J. Bartels
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cyril J. Ferrer
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Clemens Bos
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lambertus W. Bartels
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Martijn F. Boomsma
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands ,grid.452600.50000 0001 0547 5927Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Erik C. J. Phernambucq
- grid.452600.50000 0001 0547 5927Department of Radiation Oncology, Isala Hospital, Zwolle, The Netherlands
| | - Ingrid M. Nijholt
- grid.452600.50000 0001 0547 5927Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Alessio G. Morganti
- grid.6292.f0000 0004 1757 1758DIMES, Alma Mater Studiorum - Bologna University, Bologna, Italy ,grid.6292.f0000 0004 1757 1758Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giambattista Siepe
- grid.6292.f0000 0004 1757 1758Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Milly Buwenge
- grid.6292.f0000 0004 1757 1758DIMES, Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Holger Grüll
- grid.6190.e0000 0000 8580 3777Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Grischa Bratke
- grid.6190.e0000 0000 8580 3777Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sin Yuin Yeo
- grid.6190.e0000 0000 8580 3777Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roberto Blanco Sequeiros
- grid.410552.70000 0004 0628 215XDepartment of Radiology, Turku University Hospital, Turku, Finland
| | - Heikki Minn
- grid.1374.10000 0001 2097 1371Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland
| | - Mira Huhtala
- grid.1374.10000 0001 2097 1371Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland
| | - Alessandro Napoli
- grid.7841.aDepartment of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesca De Felice
- grid.7841.aDepartment of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- grid.7841.aDepartment of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alberto Bazzocchi
- grid.419038.70000 0001 2154 6641Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Chiara Gasperini
- grid.419038.70000 0001 2154 6641Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Laura Campanacci
- grid.419038.70000 0001 2154 66413Rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Julia Simões Corrêa Galendi
- grid.6190.e0000 0000 8580 3777Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Dirk Müller
- grid.6190.e0000 0000 8580 3777Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Manon N. G. J. A. Braat
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Chrit Moonen
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Helena M. Verkooijen
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Wang Z, Li L, Yang X, Teng H, Wu X, Chen Z, Wang Z, Chen G. Efficacy and safety of stereotactic body radiotherapy for painful bone metastases: Evidence from randomized controlled trials. Front Oncol 2022; 12:979201. [PMID: 36338685 PMCID: PMC9627033 DOI: 10.3389/fonc.2022.979201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/28/2022] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Pain relief is one of the main objectives of radiotherapy for cancer patients with bone metastases. Stereotactic body radiotherapy (SBRT) enables precise delivery of a higher dosage to the target area. Several trials have reported comparisons between SBRT and conventional radiotherapy (cRT) in patients with painful bone metastasis. However, the results of those investigations were inconsistent, and no systematic review or meta-analysis has been done till now. METHODS We systematically searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Clinicaltrials.gov up to May 1, 2022 for relevant studies. Patients with painful bone metastasis who received SBRT or cRT were included. The primary outcome was the patients' pain response rate at three months. The secondary outcomes included the rate of pain responders at one month and six months, oral morphine equivalent dose (OMED) use, and any adverse events. STATA software 12.0 was used for the statistical analysis. RESULTS We collected 533 patients' data from 4 randomized controlled trials (RCTs), there was a significant difference of pain response rate at 3 months between two groups (RR = 1.41, 95% CI: 1.12-1.77, I2 = 0.0%, P = 0.003). However, no significant difference was found in pain response rate at 1 month (RR = 1.19, 95% CI: 0.91-1.54, I2 = 31.5%, P = 0.201) and 6 months (RR = 1.25, 95% CI: 0.93-1.69, I2 = 0.0%, P = 0.140). OMED consumption was not significantly different in patients treated with SBRT compared with control group (WMD = -1.11, 95% CI: -17.51-15.28, I2 = 0.0%, P = 0.894). For safety outcome, no statistical difference was found between SBRT and cRT (RR = 0.72, 95% CI: 0.46-1.14, I2=20.1%, P = 0.162). CONCLUSION This study shows that for painful bone metastases, patients with SBRT experienced better pain relief 3 months after radiation than patients with cRT, and SBRT did not increase the incidence of adverse events. SYSTEMATIC REVIEW REGISTRATION https://inplasy.com/inplasy-2022-6-0099/, identifier INPLASY202260099.
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Affiliation(s)
- Zilan Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Longyuan Li
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xingyu Yang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haiying Teng
- Department of Suzhou Medical College, Soochow University, Suzhou, China
| | - Xiaoxiao Wu
- Department of Suzhou Medical College, Soochow University, Suzhou, China
| | - Zhouqing Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gang Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
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Rades D, Delikanli C, Schild SE, Kristiansen C, Tvilsted S, Janssen S. A New Survival Score for Patients ≥65 Years Assigned to Radiotherapy of Bone Metastases. Cancers (Basel) 2022; 14:cancers14194679. [PMID: 36230602 PMCID: PMC9563043 DOI: 10.3390/cancers14194679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
Survival scores are important for personalized treatment of bone metastases. Elderly patients are considered a separate group. Therefore, a specific score was developed for these patients. Elderly patients (≥65 years) irradiated for bone metastases were randomly assigned to the test (n = 174) or validation (n = 174) cohorts. Thirteen factors were retrospectively analyzed for survival. Factors showing significance (p < 0.05) or a trend (p < 0.06) in the multivariate analysis were used for the score. Based on 6-month survival rates, prognostic groups were formed. The score was compared to an existing tool developed in patients of any age. In the multivariate analysis, performance score, tumor type, and visceral metastases showed significance and gender was a trend. Three groups were designed (17, 18−25 and 27−28 points) with 6-month survival rates of 0%, 51%, and 100%. In the validation cohort, these rates were 9%, 55%, and 86%. Comparisons of prognostic groups between both cohorts did not reveal significant differences. In the test cohort, positive predictive values regarding death ≤6 and survival ≥6 months were 100% with the new score vs. 80% and 88% with the existing tool. The new score was more accurate demonstrating the importance of specific scores for elderly patients.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
- Correspondence: ; Tel.: +49-451-500-45400
| | - Cansu Delikanli
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Steven E. Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark
| | - Søren Tvilsted
- Research Department, Zealand University Hospital, 4600 Køge, Denmark
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
- Medical Practice for Radiotherapy and Radiation Oncology, 30161 Hannover, Germany
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The 100 most cited papers on bone metastasis: A bibliometric analysis. J Bone Oncol 2022; 35:100443. [PMID: 35815184 PMCID: PMC9263529 DOI: 10.1016/j.jbo.2022.100443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 06/26/2022] [Accepted: 06/26/2022] [Indexed: 12/20/2022] Open
Abstract
Citations per article in the most 100 top cited articles ranged from 357 to 2167. The leading country was USA, Canada, and United Kingdom. Clinical management of bone metastasis from different malignancy origins. Intense collaborative activity between countries and institutions was obvious between the selected papers.
Background Over the past few decades, a vast number of articles focused on bone metastasis have been published. Bibliometric analysis is helpful to determine the qualities and characteristics and to reveal the influential articles in this field. Methods All the databases in Web of Science were utilized to identify articles published from 1961 to 2020. The top 100 most cited articles on bone metastases were involved for degree centrality analysis and analyses on publication time and citations, journals, authors, geographical distribution, research institutions, and research keywords. Results The selected articles were published mainly from 1986 to 2015. The 100 most cited articles were selected from a total of 67,451 citations out of 90,502 publications with a density of 50.239 citations/year. Citations per article ranged from 357 to 2167. The leading country was USA, followed by Canada and United Kingdom. The most frequently studied themes were clinical management of bone metastasis from different malignancy origins. A co-authorship analysis revealed an intense collaborative activity between countries and institutions. Conclusions This study identified the top 100 most cited articles on bone metastasis. Publication time, area, and theme distribution were thoroughly analyzed. The present study highlighted some of the most influential contributions to the field. Clinical and academic communities have shown a sustained interest in the management of bone metastasis.
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Kanesvaran R, Castro E, Wong A, Fizazi K, Chua MLK, Zhu Y, Malhotra H, Miura Y, Lee JL, Chong FLT, Pu YS, Yen CC, Saad M, Lee HJ, Kitamura H, Prabhash K, Zou Q, Curigliano G, Poon E, Choo SP, Peters S, Lim E, Yoshino T, Pentheroudakis G. Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with prostate cancer. ESMO Open 2022; 7:100518. [PMID: 35797737 PMCID: PMC9434138 DOI: 10.1016/j.esmoop.2022.100518] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/28/2022] [Accepted: 05/22/2022] [Indexed: 11/03/2022] Open
Abstract
The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of prostate cancer was published in 2020. It was therefore decided, by both the ESMO and the Singapore Society of Oncology (SSO), to convene a special, virtual guidelines meeting in November 2021 to adapt the ESMO 2020 guidelines to take into account the differences associated with the treatment of prostate cancer in Asia. These guidelines represent the consensus opinions reached by experts in the treatment of patients with prostate cancer representing the oncological societies of China (CSCO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug access restrictions in the different Asian countries. The latter were discussed when appropriate. The aim is to provide guidance for the optimisation and harmonisation of the management of patients with prostate cancer across the different regions of Asia.
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Affiliation(s)
- R Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Programme, Duke-NUS Medical School, Singapore, Singapore.
| | - E Castro
- Department of Medical Oncology, Virgen de la Victoria University Hospital, Institute of Biomedical Research in Málaga, Malaga, Spain
| | - A Wong
- Division of Medical Oncology, National University Cancer Institute, Singapore, Singapore
| | - K Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - M L K Chua
- Oncology Academic Programme, Duke-NUS Medical School, Singapore, Singapore; Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Y Zhu
- Department of Urology, Fudan University, Shanghai Cancer Center, Shanghai, China
| | - H Malhotra
- Department of Medical Oncology, Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, India
| | - Y Miura
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - J L Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - F L T Chong
- Department of Radiotherapy and Oncology, Sabah Women and Children's Hospital, Kota Kinabalu, Malaysia
| | - Y-S Pu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - C-C Yen
- Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Medical Oncology, Center for Immuno-oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - M Saad
- Department of Clinical Oncology, University of Malaya Medical Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - H J Lee
- Department of Medical Oncology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, South Korea
| | - H Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Q Zou
- Department of Urology, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - G Curigliano
- European Institute of Oncology, IRCCS and University of Milano, Milan, Italy
| | - E Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - S P Choo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Medical Oncology, Curie Oncology, Singapore, Singapore
| | - S Peters
- Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - E Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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Stereotactic Body Radiation Therapy versus Conventional External Beam Radiation Therapy for Painful Bone Metastases: A Systematic Review and Meta-analysis of Randomized Trials. Crit Rev Oncol Hematol 2022; 178:103775. [PMID: 35917886 DOI: 10.1016/j.critrevonc.2022.103775] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To compare the efficacy and safety of stereotactic body radiation therapy (SBRT) and conventional external beam radiation therapy (cEBRT) in patients with previously unirradiated painful bone metastases (BM). METHODS We searched biomedical databases for eligible randomized trials (RCTs). The outcomes of interest were pain response, local progression, overall survival (OS) and adverse events. We used established tools to assess the quality of the individual trials and certainty of the pooled evidence. We performed meta-analyses using random effects models. RESULTS Six RCTs were identified. SBRT improved complete pain response rates at 3 months (OR, 3.38; 95% CI, 1.88-6.07; high certainty), reduced local progression rates (OR, 0.19; 95% CI, 0.06-0.62; high certainty) and increase pain flare rates. There were no differences for other outcomes. CONCLUSION Among patients with previously unirradiated painful BM, SBRT significantly improved complete pain response rates at 3 months, delayed local progression and increase pain flare rates.
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Zhang MX, Liu T, You R, Zou X, Liu YL, Ding X, Duan CY, Xu HS, Liu YP, Jiang R, Wang ZQ, Lin C, Xie YL, Chen SY, Ouyang YF, Xie RQ, Hua YJ, Sun R, Huang PY, Wang SL, Chen MY. Efficacy of local therapy to metastatic foci in nasopharyngeal carcinoma: large-cohort strictly-matched retrospective study. Ther Adv Med Oncol 2022; 14:17588359221112486. [PMID: 35860835 PMCID: PMC9290165 DOI: 10.1177/17588359221112486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Studies of local therapy (LT) to metastatic foci from nasopharyngeal carcinoma (NPC) are inconsistent and controversial. Here, we aimed to explore the survival benefit of LT directed at metastatic foci from NPC. Methods: A retrospective analysis was conducted in NPC patients with liver, lung, and/or bone metastases. The postmetastatic overall survival (OS) rate was analyzed using the Kaplan–Meier method and compared by the log-rank test. Multivariate analysis was performed using the Cox hazard model. Subgroup analyses evaluating the effect of LT were performed for prespecified covariates. Propensity score matching was applied to homogenize the compared arms. Results: Overall, 2041 of 2962 patients were eligible for analysis. At a median follow-up of 43.4 months, the 5-year OS improved by an absolute difference of 14.6%, from 46.2% in the LT group versus 31.6% in the non-LT group, which led to a hazard ratio of 0.634 for death (p < 0.001). Matched-pair analyses confirmed that LT was associated with improved OS (p = 0.003), and the survival benefits of LT remained consistent in the subcohorts of liver and lung metastasis (p = 0.009 and p = 0.007, respectively) but not of bone metastasis (BoM; p = 0.614). Radiotherapy was predominantly used for BoM and biological effective dose (BED) >60 Gy was found to yield more survival benefit than that of BED ⩽ 60 Gy. Conclusions: The addition of LT directed at metastasis has demonstrated an improvement to OS compared with non-LT group in the present matched-pair study, especially for patients with liver and/or lung metastases.
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Affiliation(s)
- Meng-Xia Zhang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ting Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rui You
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiong Zou
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yong-Long Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xi Ding
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Han-Shi Xu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - You-Ping Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rou Jiang
- Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhi-Qiang Wang
- Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical University, No.1 School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan, China
| | - Chao Lin
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yu-Long Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Si-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yan-Feng Ouyang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ruo-Qi Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yi-Jun Hua
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rui Sun
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Pei-Yu Huang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shun-Lan Wang
- Department of Otolaryngology, The first Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ming-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China
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AKIN M, DUZOVA M. Single fraction image guided radiation therapy for management of bone metastases during the COVID-19 pandemic. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1112225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Radiation therapy (RT) plays a major role in management of bone metastases, however, various dose-fractionation schemes are utilized taking into account patient, tumor, and treatment characteristics. The aim of this study was to assess Image Guided Single Fraction Radiation Therapy (IG-SFRT) for management of painful bone metastases during the COVID-19 pandemic.
Material and Method: Patients receiving IG-SFRT for painful bone metastases were assessed for age, gender, primary cancer diagnosis, location of metastases, performance status, analgesic intake, pain relief, and overall treatment efficacy in this study.
Results: Out of the total 65 patients treated with IG-SFRT during the course of COVID-19 pandemic at our department, 54 patients were evaluable for overall treatment efficacy analysis. Based on the international consensus on palliative RT endpoints, rates of complete response (CR), partial response (PR), pain progression (PP), and indeterminate response (IR) were 16.67%, 59.26%, 9.26%, 14.81%, respectively corresponding to an overall response rate of 75.93%. IG-SFRT was well tolerated by all patients without toxicity.
Conclusion: For patients with bone metastases, pain palliation is a critical aspect of management. In view of the high rate of overall treatment efficacy achieved with IG-SFRT in our study, we suggest routine utilization of this image guided radiotherapeutic approach for management of painful bone metastases which additionally allows for minimization of treatment visits thereby improving patient and treatment facility convenience under the special circumstances of the recent COVID-19 pandemic.
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Behroozian T, Navarro I, Hoskin P, Johnstone C, Recht A, Menten J, Oldenburger E, van der Linden Y, van der Velden JM, Nguyen QN, Simone CB, Johnstone P, Lutz S, Milton L, Andratschke N, Willmann J, Kazmierska J, Spałek M, Chow E, Raman S. Update on the systematic review/meta-analysis of uncomplicated bone metastases treated with external beam radiation. Radiother Oncol 2022; 174:109-110. [PMID: 35850265 DOI: 10.1016/j.radonc.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/08/2022] [Accepted: 07/09/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Tara Behroozian
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Inmaculada Navarro
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom; Division of Cancer Sciences, University of Manchester, United Kingdom
| | - Candice Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abram Recht
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Johan Menten
- Department of Radiation Oncology, University Hospital Leuven, Herestraat 49, B3000 Leuven, Belgium
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospital Leuven, Herestraat 49, B3000 Leuven, Belgium
| | - Yvette van der Linden
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands; Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Joanne M van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles B Simone
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Johnstone
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Stephen Lutz
- Eastern Woods Radiation Oncology, Blanchard Valley Health Organization, Findlay, OH, USA
| | - Lauren Milton
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Joanna Kazmierska
- Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland
| | - Mateusz Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
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ESTRO ACROP guidelines for external beam radiotherapy of patients with complicated bone metastases. Radiother Oncol 2022; 173:240-253. [DOI: 10.1016/j.radonc.2022.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 12/19/2022]
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