Bone density and pain response following intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for vertebral metastases - secondary results of a randomized trial

Sprave, Tanja; Verma, Vivek; Forster, R. E.; Schlampp, Ingmar; Hees, Katharina; Brückner, Thomas; Bostel, Tilman; Shafie, Rami A El; Welzel, Thomas; Nicolay, Nils H.; Debus, Jürgen; Rief, Harald

doi:10.1186/s13014-018-1161-4

Cited by 20 publications

(16 citation statements)

References 19 publications

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“…These studies uniformly showed an increase in density after radiation. Also, with the exception of one study in which osteolytic and osteoblastic lesions were markedly underrepresented [8], these studies indicated that increased density following radiation trended toward or was significantly greater in magnitude as the lytic component of lesions increased across different histologies and lesion sites. Bone pain, opioid consumption, and quality of life have all been demonstrated to be inversely correlated with bone density.…”

Section: Discussionmentioning

confidence: 90%

“…There has been some suggestion that even bone outside of the radiation field may have its density impacted due to effects on bone marrow stem cells [24]. However, this has not been a consistent finding [8,10,17,23].…”

Section: Discussionmentioning

confidence: 99%

“…Others have tried to evaluate treatment outcomes based on bone density using CT scans, some after radiation [6][7][8][9][10][11][12][13][14][15][16][17], and others after chemotherapy [18] or bisphosphonates [19]. The radiation studies have been limited by few patients, short follow-up, and high patient drop-off due to death.…”

Section: Discussionmentioning

confidence: 99%

“…Some of these studies reported outcomes for lesions subjectively grouped as osteolytic, osteoblastic, or mixed [6][7][8][9]13,17]. These studies uniformly showed an increase in density after radiation.…”

Section: Discussionmentioning

confidence: 99%

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Bone Density Changes Following Radiotherapy to Vertebral Metastases

Jensen¹,

Gaddipati²,

Hammonds³

et al. 2021

Cureus

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IntroductionPatients have increasing longevity and time for bone healing following radiotherapy (RT) for treatment of bone metastases (BM). Attempts to assess the treatment response of bone metastases have been either limited or heavily subjective. Our goal was to try to quantitate cancer-involved bone changes after RT using changes in bone mineral density (BMD) from computer tomographic (CT) imaging. MethodsRetrospectively, 117 spinal metastases were identified that received RT with follow-up CT scans >9 months following CT simulation. Contoured volumes included: the metastasis (gross tumor volume; GTV); the involved vertebra (gross bone volume; GBV); a total lytic volume (Lyt); a dominant lytic volume (Domlyt); a control volume, and the nearest uninvolved, unirradiated vertebra (control bone volume; CBV). The Hounsfield-density calibration curve was used to measure the density of these volumes before and after treatment. ResultsWhether using raw or control-adjusted changes, the absolute and percent change in density of the GBV, GTV, Lyt, and Domlyt volumes all significantly increased (each p<0.0001). The increase in the density of Domlyt volumes was greater than that of Lyt volumes (p=0.0465), which were greater than GTV (p=0.0065), which were greater than GBV (p<0.0001). On multivariate analysis, only the biologically effective dose (BED) dose significantly correlated with GTV density change (p=0.0175). K means clustering created groups by initial lesion size, GTV, or GBV density. A significant difference in GTV density change was not detected between any groups. ConclusionIncreases in BMD are associated with healing regardless of lesion size or initial density. A prospective study to determine whether long-term control is related to early density measurements is needed.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Bone Density Changes Following Radiotherapy to Vertebral Metastases

Jensen¹,

Gaddipati²,

Hammonds³

et al. 2021

Cureus

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“…Rapid pain relief (even after 24 h), observed in some patients, indicates a decrease of inflammatory cell activity as well as chemical pain mediators concentration in the radiation field, which play a role in the analgesic effect of radiation [15]. The RT fractionation scheme in patients with bone metastasis influences the level of mineralization, bone density, and recalcification of the irradiated site [16,17], which is associated with pain response. The recalcification rate was lower in the single fraction group (120%) compared to patients who received fractionated RT (173%, p < 0.0001) with a slight trend favouring 10 × 3 Gy RT scheme [17].…”

Section: Painful Bone Metastasesmentioning

confidence: 99%

Personalized Radiation Therapy in Cancer Pain Management

Sierko

Hempel

Zuzda

et al. 2019

Cancers

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The majority of advanced cancer patients suffer from pain, which severely deteriorates their quality of life. Apart from analgesics, bisphosphonates, and invasive methods of analgesic treatment (e.g., intraspinal and epidural analgesics or neurolytic blockades), radiation therapy plays an important role in pain alleviation. It is delivered to a growing primary tumour, lymph nodes, or distant metastatic sites, producing pain of various intensity. Currently, different regiments of radiation therapy methods and techniques and various radiation dose fractionations are incorporated into the clinical practice. These include palliative radiation therapy, conventional external beam radiation therapy, as well as modern techniques of intensity modulated radiation therapy, volumetrically modulated arch therapy, stereotactic radiosurgery or stereotactic body radiation therapy, and brachytherapy or radionuclide treatment (e.g., radium-223, strontium-89 for multiple painful osseous metastases). The review describes the possibilities and effectiveness of individual patient-tailored conventional and innovative radiation therapy approaches aiming at pain relief in cancer patients.

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Use and Reporting of Patient-Reported Outcomes in Trials of Palliative Radiotherapy

et al. 2022

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ImportanceApproximately 50% of all patients with cancer have an indication for radiotherapy, and approximately 50% of radiotherapy is delivered with palliative intent, with the aim of alleviating symptoms. Symptoms are best assessed by patient-reported outcomes (PROs), yet their reliable interpretation requires adequate reporting in publications.ObjectiveTo investigate the use and reporting of PROs in clinical trials of palliative radiotherapy.Evidence ReviewThis preregistered systematic review searched PubMed/Medline, EMBASE, and the Cochrane Center Register of Controlled Trials for clinical trials of palliative radiotherapy published from 1990 to 2020. Key eligibility criteria were palliative setting, palliative radiotherapy as treatment modality, and clinical trial design (per National Institutes of Health definition). Two authors independently assessed eligibility. Trial characteristics were extracted and standard of PRO reporting was assessed in adherence to the Consolidated Standards of Reporting Trials (CONSORT) PRO extension. The association of the year of publication with the use of PROs was assessed by logistic regression. Factors associated with higher CONSORT-PRO adherence were analyzed by multiple regression. This study is reported following the PRISMA guidelines.FindingsAmong 7377 records screened, 225 published clinical trials representing 24 281 patients were eligible. Of these, 45 trials (20%) used a PRO as a primary end point and 71 trials (31%) used a PRO as a secondary end point. The most prevalent PRO measures were the Numeric Rating Scale/Visual Analogue Scale (38 trials), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 (32 trials), and trial-specific unvalidated measures (25 trials). A more recent year of publication was significantly associated with a higher chance of PROs as a secondary end point (odds ratio [OR], 1.04 [95% CI, 1.00-1.07]; P = .03) but not as primary end point. Adherence to CONSORT-PRO was poor or moderate for most items. Mean (SD) adherence to the extension adherence score was 46.2% (19.6%) for trials with PROs as primary end point and 31.8% (19.8%) for trials with PROs as a secondary end point. PROs as a primary end point (regression coefficient, 9.755 [95% CI, 2.270-17.240]; P = .01), brachytherapy as radiotherapy modality (regression coefficient, 16.795 [95% CI, 5.840-27.751]; P = .003), and larger sample size (regression coefficient, 0.028 [95% CI, 0.006-0.049]; P = .01) were significantly associated with better PRO reporting per extension adherence score.Conclusions and RelevanceIn this systematic review of palliative radiotherapy trials, the use and reporting of PROs had room for improvement for future trials, preferably with PROs as a primary end point.

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Bone density and pain response following intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for vertebral metastases - secondary results of a randomized trial

Cited by 20 publications

References 19 publications

Bone Density Changes Following Radiotherapy to Vertebral Metastases

Bone Density Changes Following Radiotherapy to Vertebral Metastases

Personalized Radiation Therapy in Cancer Pain Management

Use and Reporting of Patient-Reported Outcomes in Trials of Palliative Radiotherapy

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