Randomized clinical trial with two palliative radiotherapy regimens in painful bone metastases: 30Gy in 10 fractions compared with 8Gy in single fraction

Arnalot, Palmira Foro; Fontanals, A Valls; Galcerán, Joan; Lynd, F. E.; Latiesas, Xavier Sanz; Dios, N. Rodriguez De; Castillejo, A. Reig; Bassols, M. Lacruz; Lozano, J.; Membrive, I.; Algara, Manuel

doi:10.1016/j.radonc.2008.05.018

Cited by 180 publications

(120 citation statements)

References 20 publications

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“…The median durations of overall pain relief for MFs were 3.8 and 1.8 mo after SF treatment. These results were similar to those reported for other series involving different primary cancers [24,25,34] . In our study, we found that EBRT effectively palliated painful BMs from HCC, that an 8 Gy SF and MFs resulted in equivalent pain relief, and that high-dose MF schedules may result in longer lasting pain relief.…”

Section: Radiotherapy For Bone Painsupporting

confidence: 92%

“…Similar findings concerning the pain relief after treatment based on an SF or MFs have also been reported [26,34] . Similarly, according to other recent studies including a meta-analysis, both SF and MF-based treatments have provided equivalent pain relief, although SF treatment often requires re-treatment [23][24][25]35] . In terms of pain relief, most previous studies failed to show a dose-response relationship for BMs from other primary cancers.…”

Section: Radiotherapy For Bone Painmentioning

confidence: 75%

“…Generally, pain relief is obtained in 60%-90% of treated patients, but the sites of primary tumors from these reports were mainly in the lung, breast, and prostate [23][24][25][26] . There have only been a few studies of EBRT for HCC BMs, but they show that 73%-99.5% of patients obtained overall pain improvement and 17%-44% of patients achieved complete pain relief (Table 2) [7,8,[27][28][29][30] .…”

Section: Radiotherapy For Bone Painmentioning

confidence: 99%

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Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma

Hayashi

Tanaka

Hoshi

2014

WJH

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The incidence of bone metastases (BMs) from hepatocellular carcinoma (HCC) is relatively low compared to those of other cancers, but it has increased recently, especially in Asian countries. Typically, BMs from HCC appear radiologically as osteolytic, destructive, and expansive components with large, bulky soft-tissue masses. These soft-tissue masses are unique to bone metastases from HCC and often replace the normal bone matrix and exhibit expansive growth. They often compress the peripheral nerves, spinal cord, or cranial nerves, causing not only bone pain but also neuropathic pain and neurological symptoms. In patients with spinal BMs, the consequent metastatic spinal cord compression (MSCC) causes paralysis. Skull base metastases (SBMs) with cranial nerve involvement can cause neurological symptoms. Therefore, patients with bony lesions often suffer from pain or neurological symptoms that have a severe, adverse effect on the quality of life. External-beam radiotherapy (EBRT) can effectively relieve bone pain and neurological symptoms caused by BMs. However, EBRT is not yet widely used for the palliative management of BMs from HCC because of the limited number of relevant studies. Furthermore, the optimal dosing schedule remains unclear, despite clinical evidence to support single-fraction radiation schedules for primary cancers. In this review, we outline data describing palliative EBRT for BMs from HCC in the context of (1) bone pain; (2) MSCC; and (3) SBMs.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Hepatocellular carcinoma; Metastasis; Radiotherapy; Palliative therapy; Spinal cord compression; Skull base metastasis Core tip: Due to a lack of clinical data, external-beam radiotherapy (EBRT) for bone metastases (BMs) from hepatocellular carcinoma (HCC) is still not widely used as a palliative therapy component, and the optimal dosing schedule remains unclear. BMs from HCC typically occur as expansive, bulky soft-tissue masses; they exhibit expansive growth that compresses the peripheral nerves, spinal cord, or cranial nerves, causing both bone and neuropathic pain, and neurological symptoms. In this review, we outline the data describing palliative EBRT for BMs from HCC to treat bone pain, spinal compression, and skull base metastases.Hayashi S, Tanaka H, Hoshi H. Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma.

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Section: Radiotherapy For Bone Painsupporting

confidence: 92%

Section: Radiotherapy For Bone Painmentioning

confidence: 75%

Section: Radiotherapy For Bone Painmentioning

confidence: 99%

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Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma

Hayashi

Tanaka

Hoshi

2014

WJH

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“…Radiation can improve pain symptoms in 50%-60% of patients and should routinely be considered. For most patients, data support the use of short-course radiation (that is, a single faction) rather than longer courses 61,62 . To support patient-centred care, many institutions have set up specific radiation clinics for the management of symptomatic bone metastases.…”

Section: Bone Directed Therapymentioning

confidence: 99%

The Importance of Multidisciplinary Team Management of Patients with Non-Small-Cell Lung Cancer

Ellis

2012

Current Oncology

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Historically, a simple approach to the treatment of non-small-cell lung cancer (nsclc) was applicable to nearly all patients. Recently, a more complex treatment algorithm has emerged, driven by both pathologic and molecular phenotype. This increasing complexity underscores the importance of a multidisciplinary team approach to the diagnosis, treatment, and supportive care of patients with nsclc. A team approach to management is important at all points: from diagnosis, through treatment, to end-of-life care. It also needs to be patient-centred and must involve the patient in decision-making concerning treatment. Multidisciplinary case conferencing is becoming an integral part of care. Early integration of palliative care into the team approach appears to contribute significantly to quality of life and potentially extends overall survival for these patients. Supportive approaches, including psychosocial and nutrition support, should be routinely incorporated into the team approach. Challenges to the implementation of multidisciplinary care require institutional commitment and support. KEY WORDSNon-small-cell lung cancer, multidisciplinary care INTRODUCTIONLung cancer is a major public health problem and the cause of the largest number of deaths from cancer in Canada, with approximately 25,500 new cases having been diagnosed and 20,600 deaths having occurred in 2011 1 . Despite the magnitude of this health problem, significant stigmas are associated with a diagnosis of lung cancer 2,3 . Questions have even been raised about whether treatment should be offered for a smoking-related illness. Historically, much nihilism surrounds the effectiveness of systemic therapies, and only since the early 1990s has sufficient evidence been developed to support the routine use of chemotherapy for advanced nonsmall-cell lung cancer (nsclc) 4 .Fortunately, significant advances in the management of nsclc have been made since 2000. Data have emerged supporting not only first-, but also secondand third-line therapies [5][6][7] . Postoperative adjuvant therapy has become the standard of care for many patients with resected nsclc 8,9 . Combined-modality treatment approaches-either chemoradiation 10 or trimodality treatments 11 -are widely adopted for well-functioning patients with locally advanced disease. Histologic differentiation of squamous from non-squamous disease has become a factor in treatment selection 12 , and the discovery of molecular abnormalities in the EGFR (epidermal growth factor receptor) gene 13,14 and the ALK (anaplastic lymphoma kinase) gene 15 have led to treatment approaches driven by the molecular profile of tumours 16,17 . All of those changes have moved treatment from a simple approach applicable in most patients to a more complicated algorithm in which histology and molecular phenotype are important factors. This increasing complexity underscores the importance of taking a multidisciplinary approach to management that extends throughout the continuum of care from diagnosis to supportive and end-of-lif...

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“…Gagnon demonstrated statistically significant improvement in pain scores lasting throughout 4 years of follow-up (Gagnon et al, 2009). Ryu found the median duration of pain relief to be 13.6 months with SBRT (Ryu et al, 2008), which is a dramatic improvement compared to the average 3 to 6 months of palliation with conventional therapy (Gaze et al, 1997;Foro Arnalot et al, 2008). Additionally, spinal SBRT treatments have been effective in achieving local control in tumors typically resistant to radiotherapy, such as renal cell carcinoma and melanoma, reportedly due in part to radiation injury to the tumor vasculature (Gerszten et al, 2007;Gibbs et al, 2007;Ryu et al, 2008;Gagnon et al, 2009).…”

Section: Stereotactic Body Radiotherapy (Sbrt): a More Effective Higmentioning

confidence: 99%

STAT RAD: A Potential Real-Time Radiation Therapy Workflow

Wilson¹,

Sheng²,

Yang³

et al. 2012

Modern Practices in Radiation Therapy

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Randomized clinical trial with two palliative radiotherapy regimens in painful bone metastases: 30Gy in 10 fractions compared with 8Gy in single fraction

Cited by 180 publications

References 20 publications

Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma

Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma

The Importance of Multidisciplinary Team Management of Patients with Non-Small-Cell Lung Cancer

STAT RAD: A Potential Real-Time Radiation Therapy Workflow

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