A prospective randomised trial of 4 Gy or 8 Gy single doses in the treatment of metastatic bone pain

Hoskin, P.; Price, Patricia M; Easton, Douglas F.; Regan, John D.; Austin, D E; Palmer, Sylvain; Yarnold, John

doi:10.1016/0167-8140(92)90338-u

Cited by 230 publications

(97 citation statements)

References 5 publications

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“…Pain is one of the most unpleasant symptoms for a patient with bone metastasis [13], and is effectively lessened by external radiation [14][15][16]. Effective doses were reported to be a total of 40 Gy or more, and of 4 Gy or more at one time [14,16,17]. In this patient's case, radiotherapy was interrupted when the total dose reached 20 Gy because of the marked increase in blood pressure.…”

Section: Discussionmentioning

confidence: 95%

Acutely Exacerbated Hypertension and Increased Inflammatory Signs Due to Radiation Treatment for Metastatic Pheochromocytoma.

Teno

Tanabe²,

Nomura³

et al. 1996

Endocr J

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Abstract. Hypertension and norepinephrine hypersecretion in a 59-year-old woman suffering from malignant pheochromocytoma with multiple metastases were appropriately controlled with a-and 13-blockers, and a-methyltyrosine (a-MT), a catecholamine-synthesis inhibitor. Metastasized vertebrae were treated with external radiation to relieve pain, but this treatment had to be interrupted at a total dose of 20 Gy because the patient suffered acutely exacerbated hypertension (200/110 mmHg), tachycardia (160 beats/min) and a low-grade fever. Simultaneously her serum levels of LDH, potassium, urea nitrogen, creatinine, white blood cell count, CRP and norepinephrine were significantly increased, suggesting that this episode was due to radiation-induced tissue destruction and the leakage of catecholamines and possibly interleukin-6, a cytokine mediating inflammation which is reportedly present in pheochromocytoma.The marked hypertension was controlled by continuous iv administration of phentolamine and propranolol. Athough radiation therapy effectively relieves pain due to neoplasmic metastasis to the bone, physicians should be aware that life-threatening complications such as the above occur in malignant pheochromocytoma.Sufficient pretreatment with adrenergic blocking agents and/or cc-MT and careful monitoring of the patient's general condition during radiation therapy, even at a low dose, are highly recommended.

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Section: Discussionmentioning

confidence: 95%

Acutely Exacerbated Hypertension and Increased Inflammatory Signs Due to Radiation Treatment for Metastatic Pheochromocytoma.

Teno

Tanabe²,

Nomura³

et al. 1996

Endocr J

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“…The overall response rate was 50% (7/14), and CR was achieved in only one patient (7%). The pain response outcomes in previous studies [5,[9][10][11][12][13][14][15][16][17][18][19][20] are shown in Table 5. The CR rates for reirradiation ranged from 11% to 100%, and the PR rates ranged from 31% to 78%.…”

Section: Discussionmentioning

confidence: 99%

Palliative Reirradiation for Painful Bone Metastases: Clinical Cases and Literature Review

et al. 2017

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Summary:Reirradiation to previously irradiated peripheral bone metastases for pain has been shown to be safe and effective, but no specific trial has been completed to define the indications for reirradiation of patients with recurrent symptoms of metastatic bone disease. Thus, we aimed to assess the effectiveness and prognostic factors of reirradiation for painful bone metastases. To do so, we reviewed the cases of 14 patients with painful bone metastases who had undergone reirradiation at our hospital. A favorable pain response after reirradiation was achieved in 50% (7/14) of the patients. An interval from initial radiotherapy > 6 months was a significant prognostic factor for pain response (p = 0.03). Performance status was correlated with pain response, with borderline significance (p = 0.06). No severe adverse events were reported. We conclude that reirradiation of painful bone metastases is effective in providing pain relief, especially for patients with a long interval from initial radiation and good performance status.

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“…However, certain features, especially the lack of a dose-response relationship and rapid pain relief, which may be seen especially after systemic radiotherapy when relief within 24-48 h occurs in up to 25% of patients make it unlikely that tumor shrinkage itself is accounted for the pain relief [17]. The perceived absence of a dose-response relationship also suggests that tumor shrinkage may not be important and this would not be expected with some of the very low doses, down to 4 Gy, which have been shown to cause pain relief [18]. Similarly no relation between pain relief and radiological features, either osteoblastic or osteolytic, has been reported [19].…”

Section: Radiotherapymentioning

confidence: 96%

Bisphosphonate treatment and radiotherapy in metastatic breast cancer

2008

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Patients with advanced breast cancer frequently develop metastasis to bone. Bone metastasis results in intractable pain and high risk of pathologic fractures due to osteolysis. The treatment of breast cancer patients with bone metastases requires a multidisciplinary approach. Radiotherapy is an established treatment for metastatic bone pain. It may be delivered either as a localized low dose treatment for localized bone pain or systemically for more widespread symptoms. Bisphosphonates have been shown to reduce morbidity and bone pain from bone metastases when given to patients with metastatic bone disease. In vivo studies indicate that early bisphosphonates administration in combination with radiotherapy improves remineralization and restabilization of osteolytic bone metastases in animal tumor models. This review focused on a brief discussion about biology of bone metastases, the effects of radiotherapy and bisphosphonate therapy, and possible mechanisms of combination therapy in metastatic breast cancer patients.

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A prospective randomised trial of 4 Gy or 8 Gy single doses in the treatment of metastatic bone pain

Cited by 230 publications

References 5 publications

Acutely Exacerbated Hypertension and Increased Inflammatory Signs Due to Radiation Treatment for Metastatic Pheochromocytoma.

Acutely Exacerbated Hypertension and Increased Inflammatory Signs Due to Radiation Treatment for Metastatic Pheochromocytoma.

Palliative Reirradiation for Painful Bone Metastases: Clinical Cases and Literature Review

Bisphosphonate treatment and radiotherapy in metastatic breast cancer

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