Palliative Radiotherapy Trials for Bone Metastases: A Systematic Review

Chow, Edward; Harris, Kristin; Fan, Grace; Tsao, May; Sze, W.M.

doi:10.1200/jco.2006.09.5281

Cited by 778 publications

(591 citation statements)

References 42 publications

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“…Nevertheless, it is based on a unique and large cohort of patients with bone metastases. Although the systemic treatment has changed over time, the standard local treatment for patients with painful bone metastases has remained palliative radiotherapy, with a single fraction of 8 Gy [2]. Therefore, we believe these results are still applicable to current patients with painful bone metastases.…”

Section: Discussionmentioning

confidence: 90%

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Screening for psychological distress before radiotherapy for painful bone metastases may be useful to identify patients with high levels of distress

et al. 2017

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Background: Psychological distress (PD) has a major impact on quality of life. We studied the incidence of PD before and after radiotherapy for painful bone metastases. Furthermore, we aimed to identify factors predictive for PD. Methods: Between 1996 and 1998, the Dutch Bone Metastasis Study included 1157 patients with painful bone metastases. Patients were randomized between two fractionation schedules. The study showed a pain response of 74% in both groups. Patients filled out weekly questionnaires for 13 weeks, then monthly for two years. The questionnaires included a subscale for PD on the Rotterdam Symptom Checklist. We used generalized estimating equations and multivariable logistic regression analyses. Results: At baseline, 290 patients (27%) had a high level of PD. For the entire group, the level of PD remained constant over time. The majority of patients with a low level of PD at baseline remained at a low level during follow-up. In patients with a high level of PD at baseline, the mean level of PD decreased after treatment and stabilized around the cutoff level. Female patients, higher age, worse performance, lower pain score and worse self-reported QoL were associated with an increased chance of PD, although the model showed moderate discriminative power. Conclusions: A substantial proportion of patients had a high level of PD before and after radiotherapy for painful bone metastases. Most patients who reported high levels of PD when referred for palliative radiotherapy remained at high levels thereafter. Therefore, screening of PD prior to treatment seems appropriate, in order to select patients requiring intervention.

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Section: Discussionmentioning

confidence: 90%

“…The pain response rate is above 60%, with the golden standard of a single fraction of 8 Gray (Gy) [1][2][3]. Although reduction of pain is the main treatment goal, it is also important to focus on quality of life (QoL) [4].…”

Section: Introductionmentioning

confidence: 99%

Screening for psychological distress before radiotherapy for painful bone metastases may be useful to identify patients with high levels of distress

et al. 2017

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“…With bone metastases, numerous randomized trials have found no difference in response rate with singlefraction (one day) radiation compared with courses extending daily over one to two weeks. 3 The likelihood of retreatment was higher with single-fraction radiation, although this may represent a patient or physician's willingness to retreat after a single fraction as opposed to retreatment after multiple fractions. 3 With brain metastases, single-fraction whole-brain radiotherapy has shown increased toxicity, but a recent Cochrane review of whole-brain radiation found no difference between five daily fractions compared with longer treatment regimens in terms of symptom control, neurologic function, or overall …”

Section: Discussionmentioning

confidence: 99%

Palliative Radiation Before Hospice: The Long and the Short of It

Yeung

Mitchell

Roeland

et al. 2014

Journal of Pain and Symptom Management

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Context. Randomized data support shorter radiotherapy courses for management of cancer-related symptoms in the palliative setting.Objectives. The purpose of this study was to evaluate the length of palliative radiotherapy before hospice enrollment among the elderly U.S. population, with a further focus on factors that influence the duration of radiation and the length of survival on hospice, including whether the duration of radiation was associated with length of survival on hospice.Methods. A total of 6982 patients with breast, prostate, lung, or colorectal cancer who received a course of radiotherapy within 30 days before hospice enrollment were identified within the Surveillance, Epidemiology, and End Results-Medicare linked database. The primary end points included the duration of palliative radiotherapy and the time from hospice enrollment through death (hospice duration). Multivariate linear regression and multivariate Cox models evaluated factors associated with the length of radiotherapy course and hospice duration.Results. The median length of palliative radiotherapy was 14 days, and the median hospice duration was 13 days. The course of palliative radiotherapy was longer than hospice duration in 48% of the patients. Breast and lung cancer were associated with longer courses of radiotherapy and shorter stays on hospice. Patients treated in freestanding radiation centers had longer courses of radiotherapy. For these groups, a longer radiotherapy course was not associated with longer hospice duration.Conclusion. This study found relatively long courses of radiotherapy before short lengths of survival on hospice. Future research is needed to identify barriers to shorter radiotherapy courses. J Pain Symptom Manage 2014;48:1070e1079.

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“…Conventional single fraction treatments (BED ~14 Gy 10 ) and multifraction treatments (BED ~30–40 Gy 10 ) have demonstrated low clinical complete response rates and suboptimal tumor control. Retreatment is often required, especially for single fraction treatments, and may be precluded by prior radiation leaving surgery as the only option 13, 14, 15, 16…”

Section: Introductionmentioning

confidence: 99%

Volumetric modulated arc therapy treatment planning of thoracic vertebral metastases using stereotactic body radiotherapy

Mallory

Pokhrel

Badkul

et al. 2018

J Applied Clin Med Phys

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Purpose/ObjectivesTo retrospectively evaluate the plan quality, treatment efficiency, and accuracy of volumetric modulated arc therapy (VMAT) plans for thoracic spine metastases using stereotactic body radiotherapy (SBRT).Materials/MethodsSeven patients with thoracic vertebral metastases treated with noncoplanar hybrid arcs (NCHA) (1 to 2 3D‐conformal partial arcs +7 to 9 IMRT beams) were re‐optimized with VMAT plans using three coplanar arcs. Tumors were located between T2 and T7 and PTVs ranged between 24.3 and 240.1 cc (median 48.1 cc). All prescriptions were 30 Gy in 5 fractions with 6 MV beams treated using the Novalis Tx linac equipped with high definition multileaf collimators (HDMLC). MR images were fused with planning CTs for target and OAR contouring. Plans were compared for target coverage using conformality index (CI), homogeneity index (HI), D90, D98, D2, and Dmedian. Normal tissue sparing was evaluated by comparing doses to the spinal cord (Dmax, D0.35, and D1.2 cc), esophagus (Dmax and D5 cc), heart (Dmax, D15 cc), and lung (V5 and V10). Data analysis was performed with a two‐sided t‐test for each set of parameters. Dose delivery efficiency and accuracy of each VMAT plan was assessed via quality assurance (QA) using a MapCHECK device. The Beam‐on time (BOT) was recorded, and a gamma index was used to compare dose agreement between the planned and measured doses.Results VMAT plans resulted in improved CI (1.02 vs. 1.36, P = 0.05), HI (0.14 vs. 0.27, P = 0.01), D98 (28.4 vs. 26.8 Gy, P = 0.03), D2 (32.9 vs. 36.0 Gy, P = 0.02), and Dmedian (31.4 vs. 33.7 Gy, P = 0.01). D90 was improved but not statistically significant (30.4 vs. 31.0 Gy, P = 0.38). VMAT plans showed statistically significant improvements in normal tissue sparing: Esophagus Dmax (22.5 vs. 27.0 Gy, P = 0.03), Esophagus 5 cc (17.6 vs. 21.5 Gy, P = 0.02), and Heart Dmax (13.1 vs. 15.8 Gy, P = 0.03). Improvements were also observed in spinal cord and lung sparing as well but were not statistically significant. The BOT showed significant reduction for VMAT, 4.7 ± 0.6 min vs. 7.1 ± 1 min for NCHA (not accounting for couch kicks). VMAT plans demonstrated an accurate dose delivery of 95.5 ± 1.0% for clinical gamma passing rate of 3%/3 mm criteria, which was similar to NCHA plans.Conclusions VMAT plans have shown improved dose distributions and normal tissue sparing compared to NCHA plans. Significant reductions in treatment time could potentially minimize patient discomfort and intrafraction movement errors. VMAT planning for SBRT is an attractive option for the treatment of metastases to thoracic vertebrae, and further investigation using alternative fractionation schedules is warranted.

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Palliative Radiotherapy Trials for Bone Metastases: A Systematic Review

Abstract: No significant differences in the arms were observed for overall and CR rates in both intention-to-treat and assessable patients. However, a significantly higher re-treatment rate with SFs was evident.

Cited by 778 publications

References 42 publications

Screening for psychological distress before radiotherapy for painful bone metastases may be useful to identify patients with high levels of distress

Screening for psychological distress before radiotherapy for painful bone metastases may be useful to identify patients with high levels of distress

Palliative Radiation Before Hospice: The Long and the Short of It

Volumetric modulated arc therapy treatment planning of thoracic vertebral metastases using stereotactic body radiotherapy

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