Determining the Incidence of Pain Flare Following Palliative Radiotherapy for Symptomatic Bone Metastases: Results From Three Canadian Cancer Centers

Hird, Amanda; Chow, Edward; Zhang, Liying; Wong, Rebecca; Wu, Jackson; Sinclair, Emily; Danjoux, Cyril; Tsao, May; Barnes, Elizabeth; Loblaw, Andrew

doi:10.1016/j.ijrobp.2008.10.044

Cited by 119 publications

(83 citation statements)

References 13 publications

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“…Biochemical markers of bone remodeling have also been used in preclinical development of antiresorptive agents for bone metastatic disease in cancer xenograft models. 30 Measurement of serum CTX-I by ELISA is a convenient and the most commonly used approach when using animal models, when compared with the quantification of NTX-I in urine.…”

Section: Preclinical Use Of Bone Remodeling Markersmentioning

confidence: 99%

Bone remodeling markers and bone metastases: From cancer research to clinical implications

Ferreira¹,

Alho²,

Casimiro³

et al. 2015

BoneKEy Reports

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Bone metastasis is a frequent finding in the natural history of several types of cancers. However, its anticipated risk, diagnosis and response to therapy are still challenging to assess in clinical practice. Markers of bone metabolism are biochemical by-products that provide insight into the tumor-bone interaction, with potential to enhance the clinical management of patients with bone metastases. In fact, these markers had a cornerstone role in the development of bone-targeted agents; however, its translation to routine practice is still unclear, as reflected by current international guidelines. In this review, we aimed to capture several of the research and clinical translational challenges regarding the use of bone metabolism markers that we consider relevant for future research in bone metastasis.

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Section: Preclinical Use Of Bone Remodeling Markersmentioning

confidence: 99%

Bone remodeling markers and bone metastases: From cancer research to clinical implications

Ferreira¹,

Alho²,

Casimiro³

et al. 2015

BoneKEy Reports

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“…First, the rapidly worsening pain after palliative radiation therapy was interpreted as radiation therapy-associated pain flare, which is experienced by approximately 40% of patients undergoing such treatment for bone metastases 6 . On the other hand, it is not uncommon for avn to be asymptomatic until sudden collapse of the cortical bone.…”

Section: (A) Plain Radiography Of the Pelvis Shows Osteoarthritic Chamentioning

confidence: 99%

When the Tumour Is Not the Culprit: Avascular Necrosis of the Hip in a Patient with Castration-Resistant Prostate Cancer

Chan¹,

Chan²,

Ehrlich

et al. 2013

Current Oncology

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Avascular necrosis (avn) of the hip is a well-documented side effect of corticosteroid therapy, but it has also been described as a complication of radiation and chemotherapy. Many prostate cancer patients undergo treatment with all three of those therapeutic modalities, and yet reported cases of avn of the hip in prostate cancer patients are rare. Symptoms that might potentially alert physicians to this complication are nonspecific and may be attributed to cancer progression, in particular to progressive bone metastasis. Here, we report on a 79-year-old man diagnosed with castration-resistant prostate cancer whose diagnosis of avn of the hip was confounded by his underlying malignancy. We discuss risk factors and diagnostic clues in this differential diagnosis of acute hip pain in patients with castration-resistant prostate cancer. Physicians might maintain a high index of suspicion for avn of the hip in prostate cancer patients presenting with new-onset hip pain. Surgical intervention may help to prevent the appearance of avn-associated pain and the negative impact of advanced avn on overall quality of life.

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“…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%

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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Determining the Incidence of Pain Flare Following Palliative Radiotherapy for Symptomatic Bone Metastases: Results From Three Canadian Cancer Centers

Cited by 119 publications

References 13 publications

Bone remodeling markers and bone metastases: From cancer research to clinical implications

Bone remodeling markers and bone metastases: From cancer research to clinical implications

When the Tumour Is Not the Culprit: Avascular Necrosis of the Hip in a Patient with Castration-Resistant Prostate Cancer

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

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