Dexamethasone for the prevention of a pain flare after palliative radiotherapy for painful bone metastases: a multicenter double-blind placebo-controlled randomized trial

Westhoff, Paulien G.; Graeff, Alexander de; Geerling, J.; Reyners, Anna K.L.; Linden, Yvette M. van der

doi:10.1186/1471-2407-14-347

Cited by 15 publications

(13 citation statements)

References 10 publications

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“…The importance of prophylactic dose of dexamethasone was reported by Westhoff et al by using randomized control trial (13). Therefore, we need prophylactic dose of steroid in short course radiotherapy in Japanese population.…”

Section: Discussionmentioning

confidence: 91%

“…Pain flare has sometimes been reported in association with total body irradiation (TBI) and radionuclide therapy, but rarely in association with local radiotherapy. Recently, some reports on the subject of pain flare after palliative radiotherapy for bone metastasis were written by a Canadian group, American group and Netherland group (12)(13)(14). Loblaw et al noted that 15 of 44 (34%) patients experienced a pain flare that lasted a median of 3 days.…”

Section: Introductionmentioning

confidence: 99%

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A Single or Short Course of Palliative Radiotherapy Increases the Risk of Pain Flare

Tanaka

Oguchi

2016

Rep Radiother Oncol

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Objectives: To evaluate the incidence of pain flare after palliative radiation for painful osseous metastases, and whether a single or short course of radiotherapy increases the risk of pain flare using a physician-based assessment. Methods: A series of 34 consecutive patients who underwent palliative radiotherapy were included in this analysis. Their treatments were as follows: 8 Gy, single fraction (n = 5), 20 Gy, 5 fractions (n = 11), 30 Gy, 10 fractions (n = 18). Pain flare was defined as a 2-point increase in the present pain intensity (PPI) with no decrease in analgesic score or a 25% increase in the analgesic score with no decrease in PPI for at least 2 consecutive days. The assessment was performed by a radiation oncologist. Results: Using the definition of pain flare, 8 out of 34 (24%) patients experienced a pain flare with a median duration of 3 days (range: 2 to 6 days). The median onset of pain flare was the day after the start of radiotherapy (day 2; range, day 1 to 3). Two of the 5 (40%) patients and 4 of the 11 (36%) patients who received total doses of 8 Gy and 20 Gy, respectively, experienced a pain flare. In contrast, 2 of the 18 (11%) patients who received a total dose of 30 Gy experienced a pain flare. Conclusions: Pain flare is common after palliative radiotherapy for bone metastases. Single fraction or short course radiotherapy may be associated with a higher risk of pain flare.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

A Single or Short Course of Palliative Radiotherapy Increases the Risk of Pain Flare

Tanaka

Oguchi

2016

Rep Radiother Oncol

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“…Furthermore, data regarding the onset of administration of corticoids, the duration of the therapy and the optimal regimen are currently missing due to the minimal literature existing to our knowledge today. Future and ongoing phase III clinical trials may clarify on the deficiencies above (Westhoff, de Graeff, Geerling, Reyners & van der Linden, ). Nowadays, recommendation guidelines do not suggest the administration of corticoids for prevention of pain flare.…”

Section: Discussion – Conclusionmentioning

confidence: 99%

The role of radiotherapy in bone metastases: A critical review of current literature

et al. 2017

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Radiotherapy is considered the treatment of choice for painful bone metastases. However, novel modalities of radiotherapy have emerged in the concept of oligometastasic disease. In addition, the increase of overall survival of patients with bone metastatic disease in the last decades due to systemic treatments has issued the silent topic of re-irradiation. The aim of this manuscript was to present a current thorough search of relevant literature. Originally, 6,087 articles revealed from PubMed database related to radiotherapy and bone metastases. The first objective was to identify prospective randomised phase III studies dealing with bone metastases and which treated primary with radiotherapy. Abstracts and non-English citations were excluded. Twenty-three phase III clinical trials, 17 prospective studies and eight meta-analysis/systemic reviews matching with these criteria, were identified. Eleven randomised studies were comparing single dose fraction to multi-fraction schedules of radiotherapy. The overall response rates and complete response rates were not significant between the two arms. Re-irradiations rates were significantly higher for the single dose fraction arms. Stereotactic radiotherapy showed excellent tumour control rates more than 80%. All trials showed the equivalence of either single or multi-fractionated radiotherapy for metastatic bone lesions. Stereotactic irradiation is feasible and safe for oligometastatic disease. However, it seems that the single fraction of 8 Gy is superior to 4 Gy, in terms of efficacy.

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“…The pain flare phenomenon in radiotherapy might explain this finding. The pain flare may be caused tumoral edema 23) and the incidence increased in spine SBRT with higher fraction size. 24) Our study showed that PTV coverage was decreased with increasing tumor size.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Efficacy of Adaptive Intensity Modulated Radiotherapy Planning according to Tumor Volume Change in Early Stage Non-small Cell Lung Cancer with Stereotactic Body Radiotherapy

2015

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The purpose of this study is to evaluate efficacy and feasibility of adaptive radiotherapy according to tumor volume change (TVC) in early stage non-small cell lung cancer (NSCLC) using stereotactic body radiotherapy (SBRT). Twenty-two lesions previously treated with SBRT were selected. SBRT was usually performed with a total dose of 48 Gy or 60 Gy in four fractions with an interval of three to four days between treatments. For evaluation of TVC, gross tumor volume (GTV) was contoured on each cone-beam computed tomography (CBCT) image used for image guidance. Intensity modulated radiotherapy (IMRT) planning was performed in the first CBCT (CBCT1) using a baseline plan. For ART planning (ART), re-optimization was performed at 2 nd , 3 rd , and 4 th CBCTs (CBCT2, CBCT3, and CBCT4) using the same angle and constraint used for the baseline plan. The ART plan was compared with the non-ART plan, which generated copying of the baseline plan to other CBCTs. Average GTV volume was 10.7 cc. Average TVC was -1.5%, 7.3%, and -25.1% in CBCT2, CBCT3, and CBCT4 and the TVC after CBCT3 was significant (p＜0.05). However, the nine lesions were increased GTV in CBCT2. In the ART plan, V20 Gy, D1500 cc, and D1000 cc of lung were significantly decreased (p＜0.05), and V30 Gy and V32 Gy of the chest wall were also decreased (p＜0.05). While D min of planning target volume (PTV) decreased by 8.3% in the non-ART plan of CBCT2 compared with the baseline plan in lesions with increased tumor size (p=0.021), PTV coverage was not compromised in the ART plan. Based on this result, use of the ART plan may improve target coverage and OAR saving. Thus ART using CBCT should be considered in early stage NSCLC with SBRT.

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Dexamethasone for the prevention of a pain flare after palliative radiotherapy for painful bone metastases: a multicenter double-blind placebo-controlled randomized trial

Cited by 15 publications

References 10 publications

A Single or Short Course of Palliative Radiotherapy Increases the Risk of Pain Flare

A Single or Short Course of Palliative Radiotherapy Increases the Risk of Pain Flare

The role of radiotherapy in bone metastases: A critical review of current literature

Feasibility and Efficacy of Adaptive Intensity Modulated Radiotherapy Planning according to Tumor Volume Change in Early Stage Non-small Cell Lung Cancer with Stereotactic Body Radiotherapy

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