Retreatment with radiotherapy for painful bone metastases

Mithal, N.; Needham, P R; Hoskin, P.

doi:10.1016/s0936-6555(05)80933-1

Cited by 14 publications

(24 citation statements)

References 5 publications

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“…5 These results suggest the success of the treatment with no pathologic fractures, spinal cord compressions, or acute or late high-grade toxicity based on the RTOG/EORTC toxicity criteria, in patients during follow-up. 5 These findings echo those produced by Mithal et al in 1994, in which only 1 out of 7 patients suffered a relapse after a second reirradiation treatment. 9 Although only 88% of the subjects continued to benefit from the treatment 37 months after its administration, every patient responded positively to the prescribed radiotherapy initially.…”

supporting

confidence: 72%

“…5 These findings echo those produced by Mithal et al in 1994, in which only 1 out of 7 patients suffered a relapse after a second reirradiation treatment. 9 Although only 88% of the subjects continued to benefit from the treatment 37 months after its administration, every patient responded positively to the prescribed radiotherapy initially. 5 Furthermore, acquiring pain palliation for 37 months would often be ample time for those suffering from severe metastatic disease.…”

supporting

confidence: 72%

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Clinical Benefit of Reirradiation: A Case Report

Flynn

Yip

Ko³

et al. 2008

Journal of Palliative Medicine

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underwent hemilaminectomy, partial facetectomy, and tumor debulking of the left L4 vertebra. He was offered 15 Gy of radiation in five fractions for treatment of the postoperative site. These procedures completely eliminated his left intractable sciatic pain. He was then treated with zoledronic acid, an intravenous bisphosphonate, and sorafenib, an oral receptor tyrosine kinase inhibitor used for targeted therapy.By June 2006, however, the patient complained of recurring pain throughout his left leg. Magnetic resonance imaging (MRI) of the spine showed that the L4 vertebral lytic mass involving the left pedicle and transverse process had progressed. The patient was readmitted with cauda equina compression at the end of the month, and underwent widening of his previous laminectomy and tumor debulking, in July 2006, to relieve his symptoms. His targeted systemic therapy was then changed to sunitinib, an alternative oral receptor tyrosine kinase inhibitor, because repeat computed tomography (CT) scans revealed that his lung metastasis had increased in size.A CT scan in September 2006 showed a predominantly lytic metastasis of the L4 vertebral body with soft tissue extension into the epidural and paraspinal soft tissues and severe canal stenosis (Fig. 1). By October 2006, the patient was complaining of back pain with bilateral radicular dysesthesias and weakness. A posterolateral lumbar L4 spinal decompression with tumor debulking was scheduled shortly after. At the time of his surgical decompression, posterior pedicular screw instrumentation was performed from L3-5 to afford spinal stability following decompression. Polymethyacrylate bone cement (PMMA) was also inserted intraoperatively to augment the L4 vertebral body anterior column.

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supporting

confidence: 72%

supporting

confidence: 72%

Clinical Benefit of Reirradiation: A Case Report

Flynn

Yip

Ko³

et al. 2008

Journal of Palliative Medicine

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“…Other therapies used for local cancer treatment and particularly symptom control in patients with symptomatic bone metastases are strontium‐89 and irradiation 17, 23–26. Unlike pamidronate, neither strontium‐89 nor irradiation decreases the incidence rate of future skeletal complications over an extended period, nor can they be used indefinitely.…”

Section: Discussionmentioning

confidence: 99%

Pamidronate prevents skeletal complications and is effective palliative treatment in women with breast carcinoma and osteolytic bone metastases

Lipton

Theriault

Hortobágyi

et al. 2000

Cancer

613

381

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BACKGROUND Pamidronate therapy previously has been shown to reduce skeletal complications effectively for up to 12 months in breast carcinoma patients with bone metastases. The current study data provide further follow‐up results regarding the effects of long term (up to 24 months) pamidronate treatment in women with breast carcinoma and osteolytic metastases. METHODS Follow‐up results from two prospective, multicenter, randomized, double‐blind, placebo‐controlled intervention trials conducted at academic and community oncology centers were combined to provide a large data set with which to evaluate the long term efficacy and safety of pamidronate therapy. Seven hundred fifty‐four women with Stage IV breast carcinoma and osteolytic metastases were randomized to the 2 treatment arms of the trial. Three patients were excluded from the intent‐to‐treat population for the analysis. A total of 751 evaluable patients were randomized to receive either a 90‐mg intravenous pamidronate infusion (367 patients) or a placebo infusion (384 patients) every 3–4 weeks. The primary outcome measures were skeletal morbidity rate (events/year), proportion of patients developing a skeletal complication, and time to first skeletal complication. RESULTS Of the 367 women receiving pamidronate, 115 (31.3%) completed the trial and 81 (22.1%) discontinued the study due to adverse events. Of the 384 women who received placebo, 100 (26.0%) completed the study and 76 (19.8%) discontinued the study due to adverse events. The skeletal morbidity rate was 2.4 in the pamidronate group and 3.7 in the placebo group (P < 0.001). In the pamidronate group, 186 of the 367 patients (51%) had skeletal complications compared with 246 of the 384 patients in the placebo group (64%) (P < 0.001). The median time to first skeletal complication was 12.7 months in the pamidronate group and 7 months in the placebo group (P < 0.001). Six patients treated with pamidronate discontinued treatment due to drug‐related adverse events. Pain and analgesic scores were significantly worse in the placebo group compared with those patients in the pamidronate group. CONCLUSIONS In the current study, monthly infusions of 90 mg of pamidronate as a supplement to antineoplastic therapy were found to be well tolerated and superior to antineoplastic therapy alone in preventing skeletal complications and palliating symptoms for at least 24 months in breast carcinoma patients with osteolytic bone metastases. Cancer 2000;88:1082–90. © 2000 American Cancer Society.

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“…In such cases the response rates after re-irradiation are usually similar to those observed after the first course of radiotherapy. In a retrospective series of 105 patients, the overall response rate was 87% [32], while in another study, the overall response rate to reirradiation was 73% (80/109), and the complete response rate was 31% [33]. In the less likely event of pain recurrence after the 10 Â 3 Gy radiation course, re-irradiation is still feasible, but it should consider the radiobiological rules for critical organ tolerance, notably the spinal cord.…”

Section: Radiotherapymentioning

confidence: 99%

Bone health in breast cancer patients: A comprehensive statement by CECOG/SAKK Intergroup

et al. 2014

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Bone is the most common site of distant metastases in breast cancer that can cause severe and debilitating skeletal related events (SRE) including hypercalcemia of malignancy, pathologic fracture, spinal cord compression and the need for palliative radiation therapy or surgery to the bone. SRE are associated with substantial pain and morbidity leading to frequent hospitalization, impaired quality of life and poor prognosis. The past 25 years of research on the pathophysiology of bone metastases led to the development of highly effective treatment options to delay or prevent osseous metastases and SRE. Management of bone metastases has become an integral part of cancer treatment requiring expertise of multidisciplinary teams of medical and radiation oncologists, surgeons and radiologists in order to find an optimal treatment for each individual patient. A group of international breast cancer experts attended a Skeletal Care Academy Meeting in November 2012 in Istanbul and discussed current preventive measures and treatment options of SRE, which are summarized in this evidence-based consensus for qualified decision- making in clinical practice.

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Retreatment with radiotherapy for painful bone metastases

Cited by 14 publications

References 5 publications

Clinical Benefit of Reirradiation: A Case Report

Clinical Benefit of Reirradiation: A Case Report

Pamidronate prevents skeletal complications and is effective palliative treatment in women with breast carcinoma and osteolytic bone metastases

Bone health in breast cancer patients: A comprehensive statement by CECOG/SAKK Intergroup

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