Elderly Patients With Painful Bone Metastases Should be Offered Palliative Radiotherapy

Campos, Sarah; Presutti, Roseanna; Zhang, Liying; Salvo, Nadia; Hird, Amanda; Tsao, May; Barnes, Elizabeth; Danjoux, Cyril; Sahgal, Arjun; Mitera, Gunita; Sinclair, Emily; DeAngelis, Carlo; Nguyen, Janet; Napolskikh, Julie; Chow, Edward

doi:10.1016/j.ijrobp.2009.03.019

Cited by 31 publications

(26 citation statements)

References 57 publications

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“…Certainly, research in the United States has reported declining access to cancer treatment for a number of disease sites with advancing age [45][46][47]. Some researchers have argued that variations in access related to age are in fact inequitable, because older age does not preclude equivalent clinical outcomes despite additional comorbidities among the elderly [48,49]. To understand whether the variation in access by age is inequitable or not, future studies must investigate the reasons for poorer access to cancer services.…”

Section: Discussionmentioning

confidence: 99%

Inequity in access to cancer care: a review of the Canadian literature

Maddison

Asada

Urquhart

2011

Cancer Causes Control

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Despite the policy and research attention on ensuring equitable access--equal access for equal need--to health care, research continues to identify inequities in access to cancer services. We conducted a literature review to identify the current state of knowledge about inequity in access to cancer health services in Canada in terms of the continuum of care, disease sites, and dimensions of inequity (e.g., income). We searched MEDLINE, CINAHL, and Embase for studies published between 1990 and 2009. We retrieved 51 studies, which examine inequity in access to cancer services from screening to end-of-life care, for multiple cancer types, and a variety of socioeconomic, geographic, and demographic factors that may cause concern for inequity in Canada. This review demonstrates that income has the most consistent influence on inequity in access to screening, while age and geography are most influential for treatment services and end-of-life care, even after adjusting for patient need. Our review also reports on methods used in the literature and new techniques to explore. Equitable access to cancer care is vitally important in all health systems. Obtaining information on the current status of inequities in access to cancer care is a critical first step toward action.

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Section: Discussionmentioning

confidence: 99%

Inequity in access to cancer care: a review of the Canadian literature

Maddison

Asada

Urquhart

2011

Cancer Causes Control

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“…With respect to pain control, multiple systematic reviews have shown the overall pain response rate of conventional radiotherapy to be approximately 60% with a corresponding complete response rate ranging from 0% to 24%. 46–48 On the other hand, spine SBRT literature has reported complete response rates as high as 46% to 92%. 49–52 Therefore, the data does suggest that while cEBRT may be reasonably efficacious in achieving partial pain relief, its efficacy may be inferior to that of spine SBRT when it comes to complete pain relief.…”

Section: Spine Sbrt Treatment Outcomesmentioning

confidence: 99%

Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution

Tseng

Eppinga

Charest-Morin

et al. 2017

Global Spine Journal

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Study Design:A broad narrative review.Objectives:The objective of this article is to provide a technical review of spine stereotactic body radiotherapy (SBRT) planning and delivery, indications for treatment, outcomes, complications, and the challenges of response assessment. The surgical approach to spinal metastases is discussed with an overview of emerging minimally invasive techniques.Methods:A comprehensive review of the literature was conducted on the techniques, outcomes, and developments in SBRT and surgery for spinal metastases.Results:The optimal management of patients with spinal metastases is complex and requires multidisciplinary assessment from an oncologic team that is familiar with the shifting paradigm as a consequence of evolving techniques in surgery and stereotactic radiation, as well as new developments in systemic agents. The Spinal Instability Neoplastic Score and the epidural spinal cord compression (Bilsky) grading system are useful tools that facilitate communication among oncologic team members and can direct management by providing a baseline assessment of risks prior to therapy. The combined multimodality approach with “separation surgery” followed by postoperative spine SBRT achieves thecal sac decompression, improves tumor control, and avoids complications that may be associated with more extensive surgery.Conclusion:Spine SBRT is a highly effective treatment that is capable of delivering ablative doses to the target while sparing the critical organs-at-risk, chiefly the critical neural tissues, within a short and manageable schedule. At the same time, surgery occupies an important role in select patients, particularly with the expanding availability and expertise in minimally invasive techniques. With rapid adoption of spine SBRT in centers outside of the academic setting, it is imperative for the practicing oncologist to understand the relevance and application of these evolving concepts.

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“…Campos et al demonstrated that the PS, as measured by KPS, is significantly related to the response rate one month after palliative RT in patients with painful bone metastases. In their study, the response rate was 44% in patients with a KPS of ≦40, 44% in patients with a KPS of 50–60, 57% in patients with a KPS of 70–80 and 68% in patients with a KPS of 90–100; however, no such relationships were observed at two or three months [7]. Dennis et al reported that patients suffering from painful bone metastases with an estimated survival of three months whose median KPS score is 60 should still be considered for palliative RT because, in their study, the overall rate of pain relief was as favorable as 70% at one month and 63% at two months [14].…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, previous reports of detailed treatment results of palliative RT in patients with a poor PS are limited [7,8]. Yamazaki et al analyzed the feasibility of palliative RT in patients with an ECOG PS of 3–4 and found that the treatment completion rate (79%) in the patients with a PS of 3–4 was significantly worse than that (89%) observed in the patients with a PS of 0–2 [8].…”

Section: Discussionmentioning

confidence: 99%

“…Potential risks, such as serious acute side effects, discomfort associated with the waiting time for treatment, transportation, hospitalization and the duration of the RT course, are concerns in patients with a poor PS [5,6]. Few clinical studies have assessed the effects of palliative RT in patients with a poor PS, and the merit and prognostic factors of palliative RT have not been established [7,8]. …”

Section: Introductionmentioning

confidence: 99%

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Palliative radiotherapy in patients with a poor performance status: the palliative effect is correlated with prolongation of the survival time

Yamaguchi¹,

Ohguri

Matsuki³

et al. 2013

Radiat Oncol

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BackgroundThe purpose of this study was to analyze the efficacy and tolerability of palliative radiotherapy (RT) in patients with a poor performance status (PS) and to evaluate the relationship between the palliative effect and survival time.MethodsOne hundred and thirty-three patients with a poor PS (Eastern Cooperative Oncology Group 3 or 4) were treated with palliative RT using the three-dimensional conformal technique and retrospectively analyzed. Each patient's primary symptom treated with palliative RT as the major cause of the poor PS was evaluated using the second item of the Support Team Assessment Schedule (STAS) at the start and one week after the completion of palliative RT.ResultsOne hundred and fourteen (86%) of the 133 patients completed the planned palliative radiation dose. Grade 3 acute toxicity was observed in two patients (2%) and Grade 2 acute toxicity was observed in 10 patients (9%). No Grade 2 or higher late toxicities were observed, except for Grade 3 radiation pneumonitis in one patient. Improvement in the STAS scores between pre- and post-palliative RT was recorded in 76 (61%) of the 125 patients with available scores of STAS. A significant improvement in the mean STAS score between pre- and post-palliative RT was recognized (p < 0.0001). Improvement in the STAS score was found to be the most statistically significant prognostic factor for overall survival after palliative RT in both the multivariate and univariate analyses. The median overall survival time in the patients with an improvement in the STAS score was 6.4 months, while that in the patients without improvement was 2.4 months (p < 0.0005).ConclusionsPalliative RT in patients with a poor PS provides symptomatic benefits in more than half of patients without inducing severe toxicities. The palliative effect is strongly correlated with prolongation of the survival time and may contribute to improving the remaining survival time in patients with metastatic/advanced cancer with a poor PS.

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Elderly Patients With Painful Bone Metastases Should be Offered Palliative Radiotherapy

Cited by 31 publications

References 57 publications

Inequity in access to cancer care: a review of the Canadian literature

Inequity in access to cancer care: a review of the Canadian literature

Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution

Palliative radiotherapy in patients with a poor performance status: the palliative effect is correlated with prolongation of the survival time

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