Prospective randomised trial of single and multifraction radiotherapy schedules in the treatment of painful bony metastases

Price, Patricia M; Hoskin, Peter; Easton, Douglas F.; Austin, D E; Palmer, Sylvain; Yarnold, John

doi:10.1016/s0167-8140(86)80191-8

Cited by 427 publications

(159 citation statements)

References 10 publications

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“…Similar drop-out rates have been reported in the studies by Price et al (1986) and Tong et al (1982). They found that using a self-assessment technique led to a decrease in compliance to less than 50% three months after treatment.…”

Section: Discussionsupporting

confidence: 84%

“…Until now, tumour characteristics (e.g., primary histol ogy, stage, localisation of metastases (Hendrickson et al, 1976;Gilbert et al, 1977;Arcangeli et a l, 1989) and the radiotherapy method (e.g., dose and fractionation regi mens; Allen et al, 1976;Tong et al, 1982;Madsen, 1983;Blitzer, 1985;Price et al, 1986;Tombolini et 1994) have served as explanatory variables for predicting whether radiotherapy will provide pain relief. However, there is little support for the notion that either.one of these indices or even tumour shrinkage are related to pain relief by radiotherapy (Torpie, 1987;Hoskin, 1991).…”

Section: Introductionmentioning

confidence: 99%

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Pain characteristics help to predict the analgesic efficacy of radiotherapy for the treatment of cancer pain

Rutten

Crul

Toorn

et al. 1997

Pain

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It is recognised that radiotherapy provides relief for intractable pain in approximately 50% of patients with cancer pain. Unfortunately, traditional explanatory variables, such as age, gender, histology or radiation dose, do not help to predict which individuals w ill benefit from palliative radiotherapy. A non-randomised prospective clinical trial was conducted on 51 patients to evaluate the value of pain characteristics as new explanatory variables for predicting the efficacy of palliative radiotherapy for providing cancer pain relief. Two new explanatory variables were identified: the presence of radiating pain and the pain score before radiotherapy.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Pain characteristics help to predict the analgesic efficacy of radiotherapy for the treatment of cancer pain

Rutten

Crul

Toorn

et al. 1997

Pain

View full text Add to dashboard Cite

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“…In patients in whom metastases are limited to a few sites, single-fraction external-beam radiotherapy is an option for palliative pain control. 30,31 Approximately 76% of patients will have effective pain relief from this approach with a median duration of around 6 months. In addition to the low cost of localized radiotherapy, the approach also has the advantage that subsequent isolated metastases may also be treated in the same way and, if necessary, the development of pain over a larger area can be treated by wide-field or hemibody radiotherapy.…”

Section: Radiotherapymentioning

confidence: 99%

The changing pattern of management for hormone-refractory, metastatic prostate cancer

James

Bloomfield

Luscombe

2006

Prostate Cancer Prostatic Dis

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Prostate cancer responds initially to hormonal manipulation by androgen withdrawal and peripheral androgen blockade. The inevitable progression to a hormone-refractory state is accompanied by an exacerbation of local symptoms and metastatic spread, principally to the bones, which has a considerable impact on quality of life and survival. Treatment of hormonerefractory prostate cancer is palliative, and surgery and radiotherapy are used for the relief of lower urinary tract symptoms and localized painful bony metastases. Systemic treatments are not widely accepted in this setting, but clinical trials have demonstrated the potential for bone targeting agents such as strontium-89 and the bisphosphonates to palliate painful bone metastases and to delay progression in certain settings. Chemotherapy with mitozantrone in combination with steroids has previously been shown to have palliative benefits and to delay progression. The additional costs incurred by the use of chemotherapy or bone-targeting therapies may be offset by gains in overall care with fewer in-patient admissions compared with steroid monotherapy . Recent clinical trials have demonstrated that docetaxel significantly improves patient quality of life, and importantly, increases survival. Future studies investigating the timing of chemotherapy, combinations with existing treatments or other novel therapies are underway.

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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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Prospective randomised trial of single and multifraction radiotherapy schedules in the treatment of painful bony metastases

Cited by 427 publications

References 10 publications

Pain characteristics help to predict the analgesic efficacy of radiotherapy for the treatment of cancer pain

Pain characteristics help to predict the analgesic efficacy of radiotherapy for the treatment of cancer pain

The changing pattern of management for hormone-refractory, metastatic prostate cancer

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

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