Effectiveness of Reirradiation for Painful Bone Metastases: A Systematic Review and Meta-Analysis

Huisman, Merel; Bosch, Maurice A.A.J. van den; Wijlemans, Joost W.; Vulpen, Marco van; Linden, Yvette M. van der; Verkooijen, Helena M.

doi:10.1016/j.ijrobp.2011.10.080

Cited by 164 publications

(74 citation statements)

References 23 publications

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“…A recent study on radium-223 used in combination with intravenous bisphosphonates in metastatic prostate cancer showed improvements in a number of pain measures per the BPI-SF [67]. Earlier initiation of analgesics and bone-targeting agents may prove beneficial in reducing rates of radiotherapy retreatment [74].…”

Section: Discussionmentioning

confidence: 99%

Pain outcomes in patients with bone metastases from advanced cancer: assessment and management with bone-targeting agents

Patrick

Cleeland

Moos

et al. 2014

Support Care Cancer

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Bone metastases in advanced cancer frequently cause painful complications that impair patient physical activity and negatively affect quality of life. Pain is often underreported and poorly managed in these patients. The most commonly used pain assessment instruments are visual analogue scales, a single-item measure, and the Brief Pain Inventory Questionnaire-Short Form. The World Health Organization analgesic ladder and the Analgesic Quantification Algorithm are used to evaluate analgesic use. Bone-targeting agents, such as denosumab or bisphosphonates, prevent skeletal complications (i.e., radiation to bone, pathologic fractures, surgery to bone, and spinal cord compression) and can also improve pain outcomes in patients with metastatic bone disease. We have reviewed pain outcomes and analgesic use and reported pain data from an integrated analysis of randomized controlled studies of denosumab versus the bisphosphonate zoledronic acid (ZA) in patients with bone metastases from advanced solid tumors. Intravenous bisphosphonates improved pain outcomes in patients with bone metastases from solid tumors. Compared with ZA, denosumab further prevented pain worsening and delayed the need for treatment with strong opioids. In patients with no or mild pain at baseline, denosumab reduced the risk of increasing pain severity and delayed pain worsening along with the time to increased pain interference compared with ZA, suggesting that use of denosumab (with appropriate calcium and vitamin D supplementation) before patients develop bone pain may improve outcomes. These data also support the use of validated pain assessments to optimize treatment and reduce the burden of pain associated with metastatic bone disease.

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Section: Discussionmentioning

confidence: 99%

Pain outcomes in patients with bone metastases from advanced cancer: assessment and management with bone-targeting agents

Patrick

Cleeland

Moos

et al. 2014

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“…According to the prospective randomized trial of reirrad i a t i o nu n d e r t a k e nb yt h eN a t i o n a lC a n c e r Institute of Canada Clinical Trial Group, single fraction RT of 8 Gy seemed to be noninferior and less toxic than multifraction RT of 20 Gy [47]. The pain relief response rate following reirradiation is 60-70%, with complete and partial responses of about 20 and 50%, respectively [46,48], which are similar to the response rates seen with an initial effective RT. Although initial responders are more likely to respond to reirradiation than initial nonresponders, about half of the nonresponders can be expected to respond to retreatment [48].…”

Section: Reirradiation For Bone Metastasesmentioning

confidence: 99%

“…Although the American Society for Therapeutic Radiology and Oncology guidelines recommend 8 Gy in a single fraction as the standard method for palliative RT in uncomplicated painful bone metastases, reirradiation is required in 20-40% of cases [45,46]. The reirradiation rates are 2.5-fold higher after single fraction RT compared with after multifraction RT [1].…”

Section: Reirradiation For Bone Metastasesmentioning

confidence: 99%

New Paradigms of Radiotherapy for Bone Metastasis

Endo¹,

Ishihara²,

Miyawaki³

et al. 2017

Radiotherapy

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Proper care of patients with bone metastasis requires interdisciplinary treatments. Radiotherapy (RT) plays a central role in the management of painful bone metastasis. External beam RT can provide rapid successful palliation of painful bone metastasis in 50-80% of patients, is associated with very few adverse effects and leads to complete pain relief at the treated site in up to one-third of patients. Intensity-modulated RT (IMRT) or stereotactic body RT (SBRT) enables the delivery of higher doses to the target tumor while minimizing the dose to adjacent organs. Reirradiation using IMRT or SBRT is a valuable option for the management of bone metastases. A multidisciplinary team, especially one consisting of a spinal surgeon and rehabilitation physician, is particularly useful for treating patients with spinal bone metastases characterized by spinal instability. Rehabilitation intervention which increases the physical activity level and prevents deconditioning is important. Future developments in surgical procedures and RT will likely improve the management protocols for bone metastases and technology to reduce metal artifacts in radiation planning might improve the efficacy and safety of combination therapy.

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“…Huisman and colleagues performed a systematic review in which 10 of 707 articles were selected for inclusion and seven entered a meta-analysis [66]. Overall, the study quality was mediocre.…”

Section: Radiotherapymentioning

confidence: 99%

Painful Boney Metastases

Smith

Barkin

2014

American Journal of Therapeutics

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Boney metastasis may lead to terrible suffering from debilitating pain. The most likely malignancies that spread to bone are prostate, breast, and lung. Painful osseous metastases are typically associated with multiple episodes of breakthrough pain which may occur with activities of daily living, weight bearing, lifting, coughing, and sneezing. Almost half of these breakthrough pain episodes are rapid in onset and short in duration and 44% of episodes are unpredictable. Treatment strategies include: analgesic approaches with "triple opioid therapy", bisphosphonates, chemotherapeutic agents, hormonal therapy, interventional and surgical approaches, steroids, radiation (external beam radiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation, cryoablation), and intrathecal analgesics. (Korean J Pain 2013; 26: 223-241)

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Effectiveness of Reirradiation for Painful Bone Metastases: A Systematic Review and Meta-Analysis

Cited by 164 publications

References 23 publications

Pain outcomes in patients with bone metastases from advanced cancer: assessment and management with bone-targeting agents

Pain outcomes in patients with bone metastases from advanced cancer: assessment and management with bone-targeting agents

New Paradigms of Radiotherapy for Bone Metastasis

Painful Boney Metastases

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