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Fagerstrom JM. Dosimetric characterization of foam padding with posterior fields in palliative radiation therapy. Med Dosim 2023; 49:65-68. [PMID: 37673727 DOI: 10.1016/j.meddos.2023.08.003] [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: 03/29/2023] [Revised: 06/12/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023]
Abstract
Patients undergoing external beam radiation therapy for the palliative treatment of painful bony metastases may have difficulty maintaining a still position on a rigid uncovered couch top, both during CT simulation as well as during patient setup, image guidance, and treatment on the linear accelerator. For these patients, a thin foam pad or mattress is sometimes used to mitigate patient discomfort. It was desired to quantify the effect of the padding in cases in which the patient is to be treated supine with posterior beams when the majority of the beam weighting traverses both the couch and the pad. Ion chamber measurements in-phantom were acquired with 6 MV, 10 MV, and 15 MV photon beams. At depths of maximum dose, the pad resulted in a difference of signal collected ≤1%. At the phantom surface, the pad resulted in an increase in signal ranging from 1% to 6.5% for the measured beams. CT data of the pad, both with and without applied pressure, indicated that the pad had average HU values close to air.
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Affiliation(s)
- Jessica M Fagerstrom
- Northwest Medical Physics Center, Lynnwood, WA, 98036; Kaiser Permanente, Seattle, WA, 98112.
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2
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Hawkins CM, Gill AE. Introduction to interventional radiology's role in palliative care for children with cancer: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30238. [PMID: 36715273 PMCID: PMC10658401 DOI: 10.1002/pbc.30238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
As palliative care continues to be an area of increasing emphasis in pediatric oncology programs, it is important to raise awareness about minimally invasive, image-guided procedures that can supplement more conventional palliative interventions, such as systemic analgesics, external beam radiation, and locoregional anesthesia. These procedures, when performed for appropriately selected patients, can often facilitate discharge from an inpatient facility, and help patients meet their end-of-life goals. This article specifically discusses three palliative procedures performed by interventional radiologists that can assist pediatric palliative care teams in: (a) percutaneous thermal ablation of painful bone metastases, (b) cryoneurolysis, and (c) tunneled drainage catheter placement for malignant pleural effusions and ascites.
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Affiliation(s)
- C. Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Emory + Children’s Pediatric Institute, Children’s Healthcare of Atlanta, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA
| | - Anne E. Gill
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Emory + Children’s Pediatric Institute, Children’s Healthcare of Atlanta, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA
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Yerramilli D, Johnstone CA. Radiation Therapy at the End of-Life: Quality of Life and Financial Toxicity Considerations. Semin Radiat Oncol 2023; 33:203-210. [PMID: 36990637 DOI: 10.1016/j.semradonc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
In patients with advanced cancer, radiation therapy is considered at various time points in the patient's clinical course from diagnosis to death. As some patients are living longer with metastatic cancer on novel therapeutics, radiation oncologists are increasingly using radiation therapy as an ablative therapy in appropriately selected patients. However, most patients with metastatic cancer still eventually die of their disease. For those without effective targeted therapy options or those who are not candidates for immunotherapy, the time frame from diagnosis to death is still relatively short. Given this evolving landscape, prognostication has become increasingly challenging. Thus, radiation oncologists must be diligent about defining the goals of therapy and considering all treatment options from ablative radiation to medical management and hospice care. The risks and benefits of radiation therapy vary based on an individual patient's prognosis, goals of care, and the ability of radiation to help with their cancer symptoms without undue toxicity over the course of their expected lifetime. When considering recommending a course of radiation, physicians must broaden their understanding of risks and benefits to include not only physical symptoms, but also various psychosocial burdens. These include financial burdens to the patient, to their caregiver and to the healthcare system. The burden of time spent at the end-of-life receiving radiation therapy must also be considered. Thus, the consideration of radiation therapy at the end-of-life can be complex and requires careful attention to the whole patient and their goals of care.
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He J, Mai Q, Yang F, Zhuang W, Gou Q, Zhou Z, Xu R, Chen X, Mo Z. Feasibility and Clinical Value of CT-Guided 125I Brachytherapy for Pain Palliation in Patients With Breast Cancer and Bone Metastases After External Beam Radiotherapy Failure. Front Oncol 2021; 11:627158. [PMID: 33747945 PMCID: PMC7973096 DOI: 10.3389/fonc.2021.627158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the feasibility and clinical value of CT-guided iodine-125 (125I) brachytherapy for pain palliation in patients with breast cancer and bone metastases after external beam radiotherapy failure. Methods: From January 2014 to July 2016, a total of 90 patients, who had received the standard therapies for bone metastases but still suffered moderate-to-severe pain, were retrospectively studied. About 42 patients were treated with both 125I brachytherapy and bisphosphonates (Group A), and 48 patients were treated with bisphosphonates alone (Group B). Results: In Group A, 45 125I brachytherapy procedures were performed in 42 patients with 69 bone metastases; the primary success rate of 125I seed implantation was 92.9%, without severe complications. Regarding pain progression of the two groups, Group A exhibited significant relief in "worst pain," "least pain," "average pain," and "present pain" 3-day after treatment and could achieve a 12-week-remission for "worst pain," "least pain," "average pain," and "present pain." The morphine-equivalent 24-h analgesic dose at 3 days, 4 weeks, 8 weeks, and 12 weeks was 91 ± 27, 53 ± 13, 31 ± 17, and 34 ± 12 mg for Group A, and 129 ± 21, 61 ± 16, 53 ± 15, and 105 ± 23 mg for Group B. Group A experienced a lower incidence of analgesic-related adverse events and better quality of life than Group B. Conclusion: The CT-guided 125I brachytherapy is a feasible and an effective treatment for the palliation of pain caused by bone metastases from breast cancer after external beam radiotherapy failure.
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Affiliation(s)
- Jian He
- Department of Interventional Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qicong Mai
- Department of Interventional Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fangfang Yang
- Department of Medical Simulation Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenhang Zhuang
- Department of Interventional Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing Gou
- Department of Interventional Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zejian Zhou
- Department of Interventional Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rongde Xu
- Department of Interventional Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoming Chen
- Department of Interventional Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhiqiang Mo
- Department of Interventional Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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MONTIEL-JARQUÍN ÁLVAROJOSÉ, ETCHEGARAY-MORALES IVET, ROMERO-FIGUEROA MARÍADELSOCORRO, AMARO-BALDERAS EILEEN, CASTILLO-PÉREZ JOSÉJUAN, BLANCO-OCHOA LUISCARLOS, OSORIO-GARCÍA YONY, VÁZQUEZ-CRUZ EDUARDO, BARRAGÁN-HERVELLA RODOLFOGREGORIO. INCIDENCE OF SPINAL CANCER IN A TERTIARY CARE HOSPITAL IN MEXICO. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201902191844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective To determine the incidence of primary malignant bone tumors of the spine in a High Specialty Orthopedics and Traumatology Medical Unit. Methods Review study. The study included patients receiving benefits from the Mexican Social Security Institute of all ages and both sexes with malignant spinal bone tumors during the period from 2010 to 2017. The descriptive statistics used were central tendency measures and dispersion in the SPSS v. 22 program from IBM. The results are presented in tables and figures. Results There were 107 patients, 56 (52.34%) men, 51 (47.66%) women with a mean age of 59.75 + 10.76 years (minimum 35, maximum 88). There were 46,840 hospital discharges during the period, for an annual average of 5,855 and a monthly average of 487.91. Of the 107 study cases, 78 (72.89%) were in the lumbosacral, 15 (14.01%) in the cervical, and 14 (13.08%) in the thoracic region. The incidence for the period was 1.9/1000 discharges, 1.38in 2010 increasing to 2.32 in 2017. Conclusions The behavior of primary malignant spinal tumors has increased its presentation from 2010 to 2017 . Level of evidence III; Non-analytical, descriptive study.
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Di Lalla V, Fortin B, Pembroke C, Freeman C, Yassa M, Hijal T. Are radiation oncologists following guidelines? An audit of practice in patients with uncomplicated bone metastases. Tech Innov Patient Support Radiat Oncol 2019; 9:13-17. [PMID: 32095590 PMCID: PMC7033799 DOI: 10.1016/j.tipsro.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/12/2018] [Accepted: 12/22/2018] [Indexed: 12/18/2022] Open
Abstract
At our center single fraction radiotherapy is used in accordance with guidelines. Patient age, performance status and tumor histology influence treatment choice. We added a quality indicator to our performance dashboard to improve adherence. This strategy can be used in other complex practices and improve quality of care.
Background Best-practice guidelines recommend single-fraction (SFRT) instead of multi-fraction radiation therapy (MFRT) for uncomplicated symptomatic bone metastases. SFRT is comparable to MFRT in relieving pain, convenient for patients, and cost-effective. Patterns of practice in Canada reveal that SFRT is underused, with significant variability across the country. We audited SFRT use and studied factors that may influence treatment decisions at a large academic tertiary care center in Quebec, Canada. Methods Patients who received radiotherapy for uncomplicated bone metastases between February 2014 and March 2015 were reviewed. Age, gender, primary histology, site of metastases and performance status were identified as potential factors affecting fractionation. These were explored by Fisher's test on univariate analysis and logistic regression for multivariate analysis. Retreatment rates were analyzed with cumulative incidence and compared with Gray's test. Results 254 radiotherapy courses were administered to 165 patients, 85.4% of which were delivered using a single fraction of 8 Gy. Patients age less than 70 years and those with breast histology were more likely to receive MFRT (p = 0.04; p = 0.0046). Performance status (ECOG) was a significant predictor of fractionation because of high correlations between young age, breast histology, and ECOG status (p = 0.03). Follow-up was too short in 40% of patients to derive definitive conclusions on retreatment. Conclusions In accordance with current guidelines, our audit confirms that use of SFRT in patients with uncomplicated bone metastases at our center is high. We identified that patient age, primary histology, and performance status influenced fractionation. Incorporation of this quality indicator into our performance dashboard will allow assessment of retreatment differences and other criteria that may also influence treatment choice.
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Affiliation(s)
| | | | | | | | - Michael Yassa
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Tarek Hijal
- McGill University Health Centre, Montreal, Quebec, Canada
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Rozanec N, Allibhai Z, Bhatti M, Chan E, McIntosh M, Moseley D, Taremi M, Abbas A. Palliation of Vertebral Metastases with Radiotherapy: Exploration of Volumetric-Modulated Arc Therapy From Development to Implementation in Routine Clinical Practice. J Med Imaging Radiat Sci 2018; 50:68-73. [PMID: 30777251 DOI: 10.1016/j.jmir.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 08/20/2018] [Accepted: 09/06/2018] [Indexed: 12/25/2022]
Abstract
The development of volumetric-modulated arc therapy (VMAT) in radiation therapy has allowed for improved dose escalation and a decrease in radiation-induced toxicities for patients. This article will describe a single centre's experience in development and implementation of VMAT for palliation of vertebral metastases. A retrospective planning analysis of 10 cases identified that utilization of VMAT decreases overall planning time with a statistically significant improvement in target coverage when compared with the current conventional technique. PTV Dmax (P = .02), PTV V9519Gy (95%) (P = .01), dose conformation (P = 1.8e-004), and the homogeneity index (P = .019) were all superior for VMAT plans with an average PTV length of 22.46 cm. Another benefit of VMAT utilization is a significant decrease in treatment delivery time, which reduced treatment times from 9.95 minutes to 2.98 minutes. Immobilization was also carefully considered, and rotational errors were measured and fell within institutional tolerances when VMAT was delivered using simple immobilization devices. Clinical implementation of this technique, utilizing a highly conformal target volume to decrease radiation-induced toxicities and minimizing the length of time patients are required to maintain their treatment positions, aims to improve the palliative radiotherapy experience for patients with painful spinal metastases.
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Affiliation(s)
- Natalie Rozanec
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; Sheffield Hallam University, Sheffield, United Kingdom.
| | - Zishan Allibhai
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; The Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Michael Bhatti
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Edwin Chan
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Marlyn McIntosh
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Douglas Moseley
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; The Princess Margaret Cancer Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Mojgan Taremi
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; The Princess Margaret Cancer Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Ahmar Abbas
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
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Zustovich F, Pastorelli D. Therapeutic management of bone metastasis in prostate cancer: an update. Expert Rev Anticancer Ther 2016; 16:1199-1211. [PMID: 27666299 DOI: 10.1080/14737140.2016.1241148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bone metastases affect the majority of patients with castration-resistant prostate cancer (CRPC), resulting in significant morbidity and mortality. This review describes the current therapies available for the management of CRPC patients with bone metastases. Areas covered: Studies on the use of currently available therapeutic approaches for palliating pain, delaying skeletal-related events (SREs) and prolonging survival in CRPC patients with bone metastases have been examined. PubMed database was searched in May 2016 starting with the following keywords: ('castration-resistant prostate cancer' OR 'CRPC') AND 'bone metastases', and approximately 270 results were retrieved. More specific searches were then performed on the epidemiology and molecular pathogenesis (in particular, 'vicious cycle' was used as a keyword), the management of pain, SREs and survival. The following keywords were also used individually: abiraterone, cabazitaxel, denosumab, docetaxel, enzalutamide, radium-223, sipuleucel-T, samarium-153, strontium-89, zoledronate. Randomized-controlled trials, observational studies, reviews, systematic reviews and meta-analyses were selected and articles were excluded if not in English. Expert commentary: Currently, clear recommendations on the optimal use of the agents available to treat mCRPC are lacking. Therefore, to ensure patients the best treatment, both their clinical characteristics and the features of each product have to be considered.
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Cleeland C, von Moos R, Walker MS, Wang Y, Gao J, Chavez-MacGregor M, Liede A, Arellano J, Balakumaran A, Qian Y. Burden of symptoms associated with development of metastatic bone disease in patients with breast cancer. Support Care Cancer 2016; 24:3557-65. [PMID: 27022965 PMCID: PMC4917575 DOI: 10.1007/s00520-016-3154-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/07/2016] [Indexed: 11/30/2022]
Abstract
Purpose Women with breast cancer frequently develop painful bone metastases. This retrospective study was designed to longitudinally characterize patterns of patient-reported symptoms among patients with breast cancer relative to the diagnosis of bone metastases. Methods Patient records were identified from the Oncology Services Comprehensive Electronic Records (OSCER) database which includes outpatient oncology practices across the USA. Symptom burden was assessed by Patient Care Monitor (PCM) assessments, which are administered as part of routine care in a subset of these practices. Eligible patients were women diagnosed with breast cancer (ICD-9-CM 174.xx) who developed bone metastases (ICD-9-CM 198.5) and had ≥1 PCM assessment between January 2007 and December 2012. The pre-specified endpoint was the occurrence of moderate to severe symptom burden, defined as PCM score ≥4 (0–10 scale). Results One thousand one hundred five women (median age, 61) met the eligibility criteria. Worsening of symptoms, particularly fatigue and pain, occurred in the months leading up to the diagnosis of bone metastases. After bone metastases diagnosis, the rate of increase in the proportion of patients experiencing moderate/severe symptoms slowed, but continued to climb during follow-up. Median time to moderate/severe symptoms was 0.9 month for fatigue, 1 month for pain, 2.9 months for trouble sleeping, and 7.7 months for numbness/tingling. Half of the patients received bone-targeted agents after diagnosis of bone metastases. Conclusions Symptom burden, especially pain and fatigue, increased both before and after the diagnosis of bone metastases, highlighting the need for proactive monitoring and management of symptoms in breast cancer patients. Electronic supplementary material The online version of this article (doi:10.1007/s00520-016-3154-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charles Cleeland
- Department of Symptom Research, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Boulevard, Unit Number: 1450, Room Number: FCT11.5064, Houston, TX, 77030, USA.
| | | | | | | | | | - Mariana Chavez-MacGregor
- Department of Symptom Research, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Boulevard, Unit Number: 1450, Room Number: FCT11.5064, Houston, TX, 77030, USA
| | | | | | | | - Yi Qian
- Amgen Inc., Thousand Oaks, CA, USA
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García-Maroto R, García-Coiradas J, Milano G, Cebrián J, Marco F, López-Durán L. Safety and efficacy of kyphoplasty in the treatment of tumoral disease of the spine. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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11
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Abdelaziz DM, Stone LS, Komarova SV. Localized experimental bone metastasis drives osteolysis and sensory hypersensitivity at distant non-tumor-bearing sites. Breast Cancer Res Treat 2015. [PMID: 26208488 DOI: 10.1007/s10549-015-3517-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patients with breast cancer metastasis to bone suffer from inadequate pain relief. Animal models provide increased understanding of cancer-induced bone and sensory alterations. The objective of this study was to investigate the measures of pain at distant non-tumor-bearing sites in animals with localized bone metastasis. Immunocompetent BALB/c mice are injected intra-tibially with murine mammary carcinoma cells (4T1) or saline, and the sensitivity to mechanical and thermal stimuli in the contralateral paw was examined. In addition to previously demonstrated development of osteolysis and hypersensitivity to mechanical and thermal stimuli in the cancer-injected tibia, these animals exhibited an increase in sensory hypersensitivity in the contralateral limb. No bone lesions were evident on radiographs of the contralateral limbs. Histomorphometry detected decreased bone volume per tissue volume and increased osteoclast number in the contralateral tibia and vertebral bones of cancer-bearing animals. Neuroplasticity was examined by immunofluorescence for calcitonin gene-related peptide (CGRP) in sensory neurons and glial fibrillary acidic protein (GFAP) in lumbar spinal cords. CGRP-immunoreactivity and GFAP-immunoreactivity were significantly elevated both ipsilateral and contralateral in tumor-bearing animals. The anti-inflammatory and osteolysis-targeting drug rapamycin reduced hypersensitivity to mechanical and cold stimuli, attenuated GFAP over-expression, and lowered osteoclast number. The osteoclast-targeting drug pamidronate reduced sensitivity to cold and protected against bone loss. Localized bone cancer drives hypersensitivity, bone remodeling, and sensory neuron plasticity at sites distant from the primary tumor area. Drugs targeting these mechanisms may be useful in the treatment of pain distant from the primary tumor site.
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García-Maroto R, García-Coiradas J, Milano G, Cebrián JL, Marco F, López-Durán L. [Safety and efficacy of kyphoplasty in the treatment of tumoral disease of the spine]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:406-12. [PMID: 26100740 DOI: 10.1016/j.recot.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 04/12/2015] [Accepted: 05/02/2015] [Indexed: 12/24/2022] Open
Abstract
UNLABELLED Vertebral fractures in oncology patients cause significant pain and disability, with decreased quality of life. The aim of the study is to assess the efficacy and safety of kyphoplasty in this type of vertebral fracture in the acute phase. MATERIALS AND METHODS A retrospective study was conducted on 75 consecutive oncology patients with 122 acute vertebral fractures, who underwent bilateral balloon kyphoplasty, with a mean follow up of 11 months. RESULTS Almost all (91%) of the patients improved their pain level. The mean improvement in the Visual Analogue Scale (VAS) was 4.28 points (preoperative value 7.49 [SD 1.19], postoperative 3.21 [SD 0.95]). Before surgery, 53% of patients needed major opioids (40 cases), and one month after surgery only 12% (9 patients) required them. Quality of life determined by the Karnofsky index improved from 60.2 (SD 10) to 80.7 (SD 12.1). Cement leaks were found in 5.7% (7 cases), all without neurological repercussions. New fractures appeared in 11 patients. This subgroup showed a slight worsening of the initially acquired clinical improvement. No neurological or pulmonary complications related to surgical technique were found. CONCLUSIONS Kyphoplasty is an effective and safe for treating vertebral fractures in patients with cancer. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- R García-Maroto
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
| | - J García-Coiradas
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - G Milano
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - J L Cebrián
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - F Marco
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - L López-Durán
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
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Multifraction Radiotherapy for Palliation of Painful Bone Metastases: 20 Gy versus 30 Gy. TUMORI JOURNAL 2015; 101:318-22. [DOI: 10.5301/tj.5000286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2014] [Indexed: 12/22/2022]
Abstract
Aims and Background To compare 2 multifraction radiotherapy schedules in the palliation of painful bone metastases. Methods and Study Design We retrospectively analyzed clinical data of 105 patients with a total of 140 painful bone metastases who were treated with 20 Gy in 5 fractions or 30 Gy in 10 fractions. The primary tumors were breast (30%), lung (28%), and prostate (14%). The main sites of irradiation were spine (n = 79) and sacrum or pelvis (n = 39). Pain was graded by patients according to the pain numeric rating scale just before and 1 month after radiotherapy. Pain progression was defined as an increase ≥2 on pain scale after an initial response. Results The overall response rate at 1 month was 88.6%. Overall response rate was 89.6% in the 20-Gy arm and 87.3% in the 30-Gy arm (p = 0.669). The rate of complete response was statistically better in patients treated with 30 Gy (p = 0.019). The mean reduction in pain was 3.2 in the 20-Gy group and 3.6 in the 30-Gy group. Pain progression was 6.5% and 1.6%, respectively. The incidence of acute toxicity was statistically significantly higher in the 30-Gy arm (23.8%) than in the 20-Gy arm (2.6%) (p = 0.001). One pathologic fracture of the irradiated bone was observed in the 30-Gy arm. Two lesions, one in each group, were re-irradiated for pain recurrence. Pain progression was found in 6.5% of the irradiated lesions in the 20-Gy arm and in 1.6% in the 30-Gy arm. Conclusions In our series, both regimens achieved high rate of pain relief, although the group treated with higher total dose reported better complete response rate. The 30-Gy arm had a significantly higher rate of acute toxicity.
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McDonald R, Chow E, Lam H, Rowbottom L, Soliman H. International patterns of practice in radiotherapy for bone metastases: A review of the literature. J Bone Oncol 2014; 3:96-102. [PMID: 26909305 PMCID: PMC4723651 DOI: 10.1016/j.jbo.2014.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 10/26/2014] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Radiation therapy is the standard treatment for symptomatic bone metastases. Several randomized control trials and meta-analyses have concluded a similar efficacy in pain relief when comparing single versus multiple fraction regimes. However, there continues to be reluctance to conform to published guidelines that recommend a single treatment for the palliation of painful bone metastases. The purpose of this literature review is to summarize international patterns of practice, and to determine if guidelines recommending single fraction treatment have been implemented in clinical care. METHODS A literature search was conducted in Ovid Medline, Embase, and Cochrane Central. Search words included, 'bone metastases', 'radiation therapy', 'radiotherapy', 'patterns of practice', and 'dose fractionation'. Both prospective and retrospective studies that investigated the prescription of radiotherapy to bone metastases using actual patient databases were included. Articles were excluded if they investigated hypothetical scenarios. RESULTS Six hundred and thirteen results were generated from the literature search. Twenty-six articles met the inclusion criteria. Of these, 11 were Canadian, 8 were European, 6 were American, and 1 was Australian. The use of single fraction radiotherapy (SFRT) ranged from 3% to 75%, but was generally lower in American studies. Choice of fractionation depended on a variety of factors, including patient age, prognosis, site of irradiation, and physician experience. CONCLUSION Despite the publication of robust randomized control trials, meta-analyses, and clinical practice guidelines recommending the use of a single treatment to palliate uncomplicated bone metastasis, SFRT is internationally underutilized.
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Affiliation(s)
| | | | | | | | - Hany Soliman
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N3M5
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Carla R, Fabio T, Gloria B, Ernesto M. Prevention and Treatment of Bone Metastases in Breast Cancer. J Clin Med 2013; 2:151-75. [PMID: 26237068 PMCID: PMC4470234 DOI: 10.3390/jcm2030151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 12/25/2022] Open
Abstract
In breast cancer patients, bone is the most common site of metastases. Medical therapies are the basic therapy to prevent distant metastases and recurrence and to cure them. Radiotherapy has a primary role in pain relief, recalcification and stabilization of the bone, as well as the reduction of the risk of complications (e.g., bone fractures, spinal cord compression). Bisphosphonates, as potent inhibitors of osteoclastic-mediated bone resorption are a well-established, standard-of-care treatment option to reduce the frequency, severity and time of onset of the skeletal related events in breast cancer patients with bone metastases. Moreover bisphosphonates prevent cancer treatment-induced bone loss. Recent data shows the anti-tumor activity of bisphosphonates, in particular, in postmenopausal women and in older premenopausal women with hormone-sensitive disease treated with ovarian suppression. Pain is the most frequent symptom reported in patients with bone metastases, and its prevention and treatment must be considered at any stage of the disease. The prevention and treatment of bone metastases in breast cancer must consider an integrated multidisciplinary approach.
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Affiliation(s)
- Ripamonti Carla
- Supportive Care in Cancer Unit, Department of Haematology and Pediatric Onco-Haematology Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan 20133, Italy.
| | - Trippa Fabio
- Oncology Department, Radiation Oncology Centre, Santa Maria Hospital, Via T. di Joannuccio, Terni 05100, Italy.
| | - Barone Gloria
- Supportive Care in Cancer Unit, Department of Haematology and Pediatric Onco-Haematology Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan 20133, Italy.
| | - Maranzano Ernesto
- Oncology Department, Radiation Oncology Centre, Santa Maria Hospital, Via T. di Joannuccio, Terni 05100, Italy.
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