Radiation therapy for palliation of cancer-related chronic pain

Sztankay, A.

doi:10.1007/s12254-009-0156-0

Cited by 3 publications

(4 citation statements)

References 29 publications

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“…Palliative radiotherapy accounts for nearly 50% of the workload of radiotherapy departments, 1 of which the management of bone metastases constitutes the most common use 2 …”

Section: Introductionmentioning

confidence: 99%

“…Palliative radiotherapy accounts for nearly 50% of the workload of radiotherapy departments, 1 of which the management of bone metastases constitutes the most common use. 2 It is well established that patients with bone metastases experience good pain relief from radiotherapy 3 therefore, it is important that the area of pain is targeted accurately ensuring that the patient receives the full potential benefit. Accuracy and reproducibility of the patient's position are fundamental to the successful delivery of radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of set-up discrepancies using daily portal imaging during radiotherapy treatment for patients with spine and bone metastases

Young

Blyth

2011

J Radiother Pract

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It is well established that patients with bone metastases get good pain relief from radiotherapy. The aim of treatment is to achieve maximum pain relief with minimum morbidity. Accuracy and reproducibility of the patient's position are fundamental to the successful delivery of radiation therapy. It has been recognised for many years, that the accuracy of patient positioning will improve the success of radiation treatment. A previous study carried out in the department showed that the use of only a single tattoo for the set-up of palliative patients resulted in poor accuracy. The aim of this study was to assess if the addition of extra skin marks improved the set-up accuracy of palliative patients being treated for spine and bone metastases. A protocol was implemented detailing the extra skin marks to be used. Daily portal images were acquired and analysed retrospectively using anatomy matching. The results obtained were then compared with those of the previous study. The use of extra skin marks resulted in a total of 45% of images within 5 mm tolerance compared with 36% of images in patients treated with a single centre tattoo. Also, the number of images with deviations greater than 15 mm was reduced by more than 50% with the addition of extra skin marks. This study has shown that extra skin marks do increase the set-up accuracy in palliative patients treated for spine and bone metastases. Therefore, the practice of using extra skin marks has become standard protocol for all palliative patients within the department.

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“…Palliative radiotherapy accounts for nearly 50% of the workload of radiotherapy departments, 1 of which the management of bone metastases constitutes the most common use 2 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of set-up discrepancies using daily portal imaging during radiotherapy treatment for patients with spine and bone metastases

Young

Blyth

2011

J Radiother Pract

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“…1 Incidence of bone metastases is high in patients with solid tumours, with 60-84% of patients developing bone metastases. 2 RT plays a major role in symptom alleviation for this cohort of patients.…”

Section: Introductionmentioning

confidence: 95%

Set-up variation in palliative radiotherapy: one versus three skin localisation marks

et al. 2019

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Background: Accuracy and reproducibility of the patient’s position is crucial for successful delivery of radiotherapy (RT). Data on palliative patients’ set-up uncertainties are sparse. The aim of this study was to calculate set-up errors observed for palliative patients positioned using one skin mark (Group 1) versus three skin marks (Group 2) and to assess the accuracy of both approaches. Methods: Displacements in the left–right (L–R) and superior–inferior (S–I) directions were retrospectively analysed for 175 sites treated with a course of fractionated palliative RT. Population mean, systematic and random errors were calculated in both directions for patients positioned with one and three skin marks. Frequency of deviations was also examined for both groups. Results: The population mean, systematic and random errors for Group 1 and 2 for the L–R direction were 0·0, 4·4, 4·8 and 0·4, 3·1 and 3·3 mm, respectively, and in the S–I direction: 0·1, 3·4, 4·2 and 1·2, 2·7 and 3·3 mm, respectively. Frequency of images within the clinical tolerance of 5 mm was 47·1% for Group 1 and 65·9% for Group 2. Conclusion: Three skin marks are recommended for patients receiving a fractionated course of palliative RT, as it reduces set-up error, reduces the number of gross displacements (>10 mm) and increases the number of displacements within the clinically acceptable tolerance of 5 mm.

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“…Sztankay [6] outlines the role of radiation oncology in cancer pain management with a particular focus on bone metastases. Th e issue of dose fractionation is addressed from various aspects, and mechanisms underlying the well-established, various palliative eff ects of radiotherapy are elucidated.…”

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confidence: 99%

Cancer pain management – opportunities beyond the WHO ladder

Clausen

2009

memo

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Cancer-related pain remains a signifi cant clinical problem despite continuing advances in both antineoplastic therapy and supportive medicine. Th e optimal clinical management of pain can be subdivided into 3 phases:1. Realisation of the problem by the attending medical staff , including diff erential classifi cation of the individual pain syndrome, and, importantly, its quantifi cation. 2. Choice of the most appropriate treatment modality, or a combination of multiple treatment modalities. 3. Assessment of response to the analgesic regimen, and, if required, modifi cation of the pain management.Th e fi rst and the third of these phases will be briefl y addressed in this editorial, while three short reviews in this issue of memo will focus on particular treatment modalities, which, in addition to the basic analgesic regimen, should always be considered for patients with cancer pain.Undertreatment of cancer-related pain is not a subjective issue of a few, unlucky individuals, but is a frequent and well-documented problem, as indicated by a growing number of publications. A systematic review by Van den Beuken-van Everdingen and co-workers [1], covering literature of the past 4 decades, revealed an average cancer pain prevalence of 53% with a range from 33% in patients on curative treatment up to 64% in terminally ill patients with advanced, metastatic disease. Importantly, nearly half of the latter cohort suff ers from moderate or severe pain. Stratifi cation of the included studies by cancer type did not reveal huge diff erences, with head-andneck cancers leading the table with a pain incidence of 70%.A widely applied measure of the adequacy of pain management is the so-called pain management index (PMI) as proposed by Zelan, Ward and Cleeland [2,3]. Th e PMI is defi ned as the numerical diff erence between the intensity of pain treatment (rated 0 to 3, according to the WHO scale) and the original pain intensity according to the Brief Pain Inventory, categorised as 0 (no pain), 1 (1-3, mild pain), 2 (4-7, moderate pain), or 3 (8-10, severe pain). A PMI of zero or higher indicates adequate -or overtreatment, while a negative PMI defi nes undertreatment. Deandrea and colleagues recently conducted a systematic review of 26 studies including between 39 and 905 patients, respectively, published between 1994 and 2007, which assessed the PMI in cancer patients [4]. Th ey report an average incidence of 43% for pain undertreatment with a wide inter-study range from 8 to 82%. Th e most frequently reported factors associated with undertreatment were early disease stage (no distant metastases), a good performance score, and discrepancy between the patient's and the physician's estimate of pain severity. Furthermore, undertreatment was reported more frequently in studies from Europe or Asia than in those from the USA, in studies from poorer countries, and in studies published before 2001. Undertreatment was signifi cantly less frequently reported from institutions specialised in cancer treatment.More recently, the results of ...

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Radiation therapy for palliation of cancer-related chronic pain

Cited by 3 publications

References 29 publications

Assessment of set-up discrepancies using daily portal imaging during radiotherapy treatment for patients with spine and bone metastases

Assessment of set-up discrepancies using daily portal imaging during radiotherapy treatment for patients with spine and bone metastases

Set-up variation in palliative radiotherapy: one versus three skin localisation marks

Cancer pain management – opportunities beyond the WHO ladder

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