Radiation therapy for the management of painful bone metastases: Results from a randomized trial

Bayard, L. Gutiérrez; Buzón, M.D.C. Salas; Pain, E. Angulo; Barón, L. de Ingunza

doi:10.1016/j.rpor.2014.04.009

Cited by 37 publications

(20 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Radiotherapy is considered as the primary treatment for painful bone metastases. The results of our review show that there is no difference in pain response between 8 Gy single fraction, 30 Gy given in 10 fractions, 24 Gy given in six fractions, 20 Gy given in five fractions, the re‐treatment rates were significantly higher for the 8 Gy single fraction schedule (Bone Pain Trial Working Party, ; Chow, Harris, et al., ; Chow et al., ; Foro Arnalot et al., ; Gutiérrez Bayard et al., ; Hartsell et al., ; Kaasa et al., ; Koswig & Budach, ; Nielsen et al., ; Price et al., ; Roos et al., ; Steenland et al., ; Wu et al., ). However, in daily clinical routine it seems that the appropriate fractionation schedule is mostly selected based on factors related to patient characteristics and disease prognosis.…”

Section: Discussion – Conclusionmentioning

confidence: 77%

“…Six of the 11 selected randomised studies compared 8 Gy given in one fraction with 30 Gy applied in 10 fractions. The primary endpoint of these studies was pain relief (Foro Arnalot et al., ; Gutiérrez Bayard, Salas Buzón, Angulo Paín & de Ingunza Barón, ; Hartsell et al., ; Kaasa et al., ; Koswig & Budach, ; Price et al., ), as shown in Table . In these six studies, the overall and complete pain response rates were similar regardless the regimen used.…”

Section: Resultsmentioning

confidence: 99%

“…Four of the studies reported results regarding re‐irradiation, all favouring the 30 Gy fractionation schedule (Foro Arnalot et al., ; Gutiérrez Bayard et al., ; Hartsell et al., ; Kaasa et al., ). Results for the evaluation of narcotic relief were reported in three of these studies, which reported non‐significant differences between treatment schedules (Gutiérrez Bayard et al., ; Hartsell et al., ; Kaasa et al., ). Two of the six studies reported results regarding toxicity (Foro Arnalot et al., ; Hartsell et al., ).…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

The role of radiotherapy in bone metastases: A critical review of current literature

et al. 2017

View full text Add to dashboard Cite

Radiotherapy is considered the treatment of choice for painful bone metastases. However, novel modalities of radiotherapy have emerged in the concept of oligometastasic disease. In addition, the increase of overall survival of patients with bone metastatic disease in the last decades due to systemic treatments has issued the silent topic of re-irradiation. The aim of this manuscript was to present a current thorough search of relevant literature. Originally, 6,087 articles revealed from PubMed database related to radiotherapy and bone metastases. The first objective was to identify prospective randomised phase III studies dealing with bone metastases and which treated primary with radiotherapy. Abstracts and non-English citations were excluded. Twenty-three phase III clinical trials, 17 prospective studies and eight meta-analysis/systemic reviews matching with these criteria, were identified. Eleven randomised studies were comparing single dose fraction to multi-fraction schedules of radiotherapy. The overall response rates and complete response rates were not significant between the two arms. Re-irradiations rates were significantly higher for the single dose fraction arms. Stereotactic radiotherapy showed excellent tumour control rates more than 80%. All trials showed the equivalence of either single or multi-fractionated radiotherapy for metastatic bone lesions. Stereotactic irradiation is feasible and safe for oligometastatic disease. However, it seems that the single fraction of 8 Gy is superior to 4 Gy, in terms of efficacy.

show abstract

Section: Discussion – Conclusionmentioning

confidence: 77%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The role of radiotherapy in bone metastases: A critical review of current literature

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Single-fraction RT is known to be noninferior for pain relief from uncomplicated bone metastases, and has fewer toxicities. 31 , 32 , 33 Caravatta et al. also demonstrated that short-course accelerated whole brain RT (WBRT) of up to 18 Gy in 4 fractions delivered twice daily may be an alternative to 30 Gy in 10 fractions owing to its effective symptom relief and survival profile.…”

Section: Discussionmentioning

confidence: 99%

“…The actual percentage might be even higher because palliative care patients have inconsistent follow-up, and many patients have no further documentation after RT, which makes a true estimate of overall survival difficult. Single-fraction RT is known to be noninferior for pain relief from uncomplicated bone metastases, and has fewer toxicities 31, 32, 33. Caravatta et al.…”

Section: Discussionmentioning

confidence: 99%

Impact of Performance Status and Comorbidity on Palliative Radiation Treatment Tolerance and End-Of-Life Decision-Making

Perlow

Cassidy

Farnia

et al. 2019

Advances in Radiation Oncology

View full text Add to dashboard Cite

PurposePrevious studies have indicated a relationship between functional status and comorbidity on overall survival when treating patients with bone and brain metastases. However, the degree to which these findings have been integrated into modern-day practice remains unknown. This study examines the impact of performance measures, including Karnofsky Performance Status (KPS) and comorbidity, on palliative radiation therapy treatment tolerance and fractionation schedule. The relationship between a shorter fractionation schedule (SFx) and pending mortality is examined.Methods and materialsThis study included patients who were treated with palliative intent to the brain or bone between January 1, 2016 and June 30, 2016. Demographic and medical characteristics collected included KPS score (stratified as good [90-100], fair [70-80], and poor (≤60]), socioeconomic status, comorbidity (binary measure using the Adult Comorbidity Evaluation-27 scale), site of metastatic disease, and treatment facility. Univariable analyses were performed using the Cox proportional hazards regression model to assess the impact of the variables on the prescribed number of fractions (binary measure, ≥10 [long fractionation schedule], and <10 [SFx]), and major treatment interruptions (MTIs; defined as missing ≥3 radiation therapy treatment days or ending treatment prematurely).ResultsA total of 145 patients were eligible for study inclusion, including 95 patients who were treated for bony metastatic disease and 50 patients for brain metastases. High comorbidity (P = .029) and both fair (P = .051) and poor (P = .065) functional status were associated with more frequent MTIs. However, high comorbidity and low KPS score were not associated with shorter treatment plans. In addition, patients with an earlier time to death were not more likely to receive an SFx (P = .871).ConclusionsLow KPS and elevated comorbidity scores predict for a poorer prognosis and more frequent MTIs; however, there was no indication that physicians incorporated this information in the fractionation scheduling.

show abstract

Use and Reporting of Patient-Reported Outcomes in Trials of Palliative Radiotherapy

et al. 2022

View full text Add to dashboard Cite

ImportanceApproximately 50% of all patients with cancer have an indication for radiotherapy, and approximately 50% of radiotherapy is delivered with palliative intent, with the aim of alleviating symptoms. Symptoms are best assessed by patient-reported outcomes (PROs), yet their reliable interpretation requires adequate reporting in publications.ObjectiveTo investigate the use and reporting of PROs in clinical trials of palliative radiotherapy.Evidence ReviewThis preregistered systematic review searched PubMed/Medline, EMBASE, and the Cochrane Center Register of Controlled Trials for clinical trials of palliative radiotherapy published from 1990 to 2020. Key eligibility criteria were palliative setting, palliative radiotherapy as treatment modality, and clinical trial design (per National Institutes of Health definition). Two authors independently assessed eligibility. Trial characteristics were extracted and standard of PRO reporting was assessed in adherence to the Consolidated Standards of Reporting Trials (CONSORT) PRO extension. The association of the year of publication with the use of PROs was assessed by logistic regression. Factors associated with higher CONSORT-PRO adherence were analyzed by multiple regression. This study is reported following the PRISMA guidelines.FindingsAmong 7377 records screened, 225 published clinical trials representing 24 281 patients were eligible. Of these, 45 trials (20%) used a PRO as a primary end point and 71 trials (31%) used a PRO as a secondary end point. The most prevalent PRO measures were the Numeric Rating Scale/Visual Analogue Scale (38 trials), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 (32 trials), and trial-specific unvalidated measures (25 trials). A more recent year of publication was significantly associated with a higher chance of PROs as a secondary end point (odds ratio [OR], 1.04 [95% CI, 1.00-1.07]; P = .03) but not as primary end point. Adherence to CONSORT-PRO was poor or moderate for most items. Mean (SD) adherence to the extension adherence score was 46.2% (19.6%) for trials with PROs as primary end point and 31.8% (19.8%) for trials with PROs as a secondary end point. PROs as a primary end point (regression coefficient, 9.755 [95% CI, 2.270-17.240]; P = .01), brachytherapy as radiotherapy modality (regression coefficient, 16.795 [95% CI, 5.840-27.751]; P = .003), and larger sample size (regression coefficient, 0.028 [95% CI, 0.006-0.049]; P = .01) were significantly associated with better PRO reporting per extension adherence score.Conclusions and RelevanceIn this systematic review of palliative radiotherapy trials, the use and reporting of PROs had room for improvement for future trials, preferably with PROs as a primary end point.

show abstract

Radiation therapy for the management of painful bone metastases: Results from a randomized trial

Cited by 37 publications

References 24 publications

The role of radiotherapy in bone metastases: A critical review of current literature

The role of radiotherapy in bone metastases: A critical review of current literature

Impact of Performance Status and Comorbidity on Palliative Radiation Treatment Tolerance and End-Of-Life Decision-Making

Use and Reporting of Patient-Reported Outcomes in Trials of Palliative Radiotherapy

Contact Info

Product

Resources

About