Influence of pain duration on pain outcomes following palliative radiotherapy for painful tumors: the sooner the irradiation, the better?

Saitô, Tetsuo; Murotani, Kenta; Yamaguchi, Kohsei; Toya, Ryo; Tomitaka, Etsushi; Watakabe, Takahiro; Oya, Natsuo

doi:10.1007/s00066-021-01760-x

Cited by 5 publications

(3 citation statements)

References 24 publications

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“…Furthermore, based on another analysis showing that long-lasting oncologic pain is significantly worse 17 , it can be hypothesized that early palliative RT may be more effective than RT delivered to subjects with more prolonged pain. This hypothesis would be in line with a further recent analysis showing that patients treated with palliative RT and with shorter pain duration (< 1 month) had higher cumulative incidence of pain response (subdistribution hazard ratio, 2.43; 95% CI 1.35–4.38) compared with subjects with longer pain duration (≥ 4 months) 18 . However, we should also consider that the higher efficacy of early palliative RT could derive from a milder pain in the initial stages of its onset but also from the well-known refractoriness of long-lasting and therefore chronic pain.…”

Section: Discussionsupporting

confidence: 83%

Short course palliative radiotherapy in advanced solid tumors: a pooled analysis (the SHARON project)

Ferioli

Macchia

Siepe

et al. 2022

Sci Rep

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Previous trials showed the tolerability and efficacy of a palliative radiotherapy (RT) regimen (SHARON) based on the 4 fractions delivered in 2 days in different oncological settings. In order to identify possible predictors of symptomatic response, the purpose of this study is to perform a pooled analysis of previous trials. We analyzed the impact on symptomatic response of the following parameters: tumor site, histological type, performance status (ECOG), dominant symptom, and RT dose using the Chi-square test and Fisher’s exact test. One-hundred-eighty patients were analyzed. Median RT dose was 20 Gy (range: 14–20 Gy). The overall response rate was 88.8% (95% CI 83.3–92.7%) while pre- and post-treatment mean VAS was 5.3 (± 7.7) and 2.2 (± 2.2), respectively (p < 0.001). The overall response rate of pain, dyspnea, bleeding, dysphagia, and other symptoms was 86.2%, 90.9%, 100%, 87.5%, and 100%, respectively. Comparing the symptomatic effect based on the analyzed parameters no significant differences were recorded. However, patients with locally advanced disease showed a higher rate of symptomatic responses than metastatic ones (97.3% vs 83.0%; p = 0.021). Finally, the complete pain response rate was more than double in patients with mild to moderate (VAS: 4–7) compared to those with severe (VAS > 7) pain (36.0% vs 14.3%; p = 0.028). This pooled analysis showed high efficacy of the SHARON regimen in the relief of several cancer-related symptoms. The markedly and significantly higher complete pain response rate, in patients with mild-moderate pain, suggests early referral to palliative RT for patients with cancer-related pain.

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Section: Discussionsupporting

confidence: 83%

Short course palliative radiotherapy in advanced solid tumors: a pooled analysis (the SHARON project)

Ferioli

Macchia

Siepe

et al. 2022

Sci Rep

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“…One potential strategy to enhance pain control is to refer patients for palliative RT at earlier stages of the disease. Several studies have attempted to identify predictors of pain relief after RT for painful tumors [ 14 , 15 ]. It has been observed that patients with a shorter duration of pre-RT pain have a higher incidence of pain response to treatment, specifically in terms of pain caused by the irradiated tumors themselves [ 16 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Adequacy of Pain Management in Patients Referred for Radiation Therapy: A Subanalysis of the Multicenter ARISE-1 Study

Donati,

Maggiore,

Maltoni

et al. 2023

Cancers

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Background: Pain is a prevalent symptom among cancer patients, and its management is crucial for improving their quality of life. However, pain management in cancer patients referred to radiotherapy (RT) departments is often inadequate, and limited research has been conducted on this specific population. This study aimed to assess the adequacy and effectiveness of pain management when patients are referred for RT. Moreover, we explored potential predictors of adequate pain management. Methods: This observational, prospective, multicenter cohort study included cancer patients aged 18 years or older who were referred to RT departments. A pain management assessment was conducted using the Pain Management Index (PMI), calculated by subtracting the pain score from the analgesic score (PMI < 0 indicated inadequate pain management). Univariate and multivariate analyses were performed to identify predictors of adequate pain management. Results: A total of 1042 cancer outpatients were included in the study. The analysis revealed that 42.9% of patients with pain did not receive adequate pain management based on PMI values. Among patients with pain or taking analgesics and referred to palliative or curative RT, 72% and 75% had inadequate or ineffective analgesic therapy, respectively. The odds of receiving adequate pain management (PMI ≥ 0) were higher in patients undergoing palliative RT (OR 2.52; p < 0.001), with worse ECOG-PS scores of 2, 3 and 4 (OR 1.63, 2.23, 5.31, respectively; p: 0.017, 0.002, 0.009, respectively) compared to a score of 1 for those with cancer-related pain (OR 0.38; p < 0.001), and treated in northern Italy compared to central and southern of Italy (OR 0.25, 0.42, respectively; p < 0.001). Conclusions: In this study, a substantial proportion of cancer patients referred to RT departments did not receive adequate pain management. Educational and organizational strategies are necessary to address the inadequate pain management observed in this population. Moreover, increasing the attention paid to non-cancer pain and an earlier referral of patients for palliative RT in the course of the disease may improve pain response and treatment outcomes.

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“…Palliative radiotherapy plays an important role in the multimodal management of patients with incurable cancer [1,2]. Goals of treatment (pain relief, tumor growth inhibition, prolongation of survival) vary and are influenced by several patient-and disease-related factors, e.g., patient preference, performance status (PS), overall tumor burden, availability and efficacy of systemic anticancer treatment, and size of the radiation target volume [3][4][5]. The recent scientific focus on radiotherapy personalization holds promise with regard to prescription of patient-specific fractionation regimens [6,7].…”

Section: Introductionmentioning

confidence: 99%

Palliative appropriateness criteria: external validation of a new method to evaluate the suitability of palliative radiotherapy fractionation

et al. 2023

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Background Recently, the palliative appropriateness criteria (PAC) score, a novel metric to aid clinical decision-making between different palliative radiotherapy fractionation regimens, has been developed. It includes baseline parameters including but not limited to performance status. The researchers behind the PAC score analyzed the percent of remaining life (PRL) on treatment. The latter was accomplished by calculating the time between start and finish of palliative radiotherapy (minimum 1 day in case of a single-fraction regimen) and dividing it by overall survival in days from start of radiotherapy. The purpose of the present study was to validate this novel metric. Patients and methods The retrospective validation study included 219 patients (287 courses of palliative radiotherapy). The methods were identical to those employed in the score development study. The score was calculated by assigning 1 point each to several factors identified in the original study and using the online calculator provided by the PAC developers. Results Median survival was 6 months and death within 30 days from start of radiotherapy was recorded in 13% of courses. PRL on treatment ranged from 1 to 23%, median 8%. Significant associations were confirmed between online-calculated PAC score, observed survival, and risk of death within 30 days from the start of radiotherapy. Patients with score 0 had distinctly better survival than all other groups. The score-predicted median risk of death within 30 days from start of radiotherapy was 22% in our cohort. A statistically significant correlation was found between predicted and observed risk (p < 0.001). The original and present study were not perfectly concordant regarding number and type of baseline parameters that should be included when calculating the PAC score. Conclusion This study supports the dual strategy of PRL and risk of early death calculation, with results stratified for fractionation regimen, in line with the original PAC score study. When considering multifraction regimens, the PAC score identifies patients who may benefit from shorter courses. Additional work is needed to answer open questions surrounding the underlying components of the score, because the original and validation study were only partially aligned.

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Influence of pain duration on pain outcomes following palliative radiotherapy for painful tumors: the sooner the irradiation, the better?

Cited by 5 publications

References 24 publications

Short course palliative radiotherapy in advanced solid tumors: a pooled analysis (the SHARON project)

Short course palliative radiotherapy in advanced solid tumors: a pooled analysis (the SHARON project)

Adequacy of Pain Management in Patients Referred for Radiation Therapy: A Subanalysis of the Multicenter ARISE-1 Study

Palliative appropriateness criteria: external validation of a new method to evaluate the suitability of palliative radiotherapy fractionation

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