Short course palliative radiotherapy in advanced solid tumors: a pooled analysis (the SHARON project)

Ferioli, Martina; Macchia, G.; Siepe, G.; Zamagni, Alice; Benini, Anna; Cellini, Francesco; Buwenge, M.; Cilla, S.; Cammelli, Silvia; Rizzo, Stefania; Caravatta, L.; Tigeneh, Wondemagegnhu; Uddin, Aaliya; Deressa, Biniyam Tefera; Sumon, M.A.; Rizzini, Elisa Lodi; Bazzocchi, Alberto; Morganti, Alessio Giuseppe; Deodato, F.; Farina, E.

doi:10.1038/s41598-022-25602-7

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…However, many studies have demonstrated that initiating palliative treatment at earlier stages of the disease leads to less aggressive care, more adequate pain management, an improved quality of life, and increased survival rates [ 13 , 21 , 22 , 23 ]. Moreover, referring patients to palliative RT earlier may increase the probability of achieving a better pain response and overall treatment outcomes [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Adequacy of Pain Management in Patients Referred for Radiation Therapy: A Subanalysis of the Multicenter ARISE-1 Study

Donati,

Maggiore,

Maltoni

et al. 2023

Cancers

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Background: Pain is a prevalent symptom among cancer patients, and its management is crucial for improving their quality of life. However, pain management in cancer patients referred to radiotherapy (RT) departments is often inadequate, and limited research has been conducted on this specific population. This study aimed to assess the adequacy and effectiveness of pain management when patients are referred for RT. Moreover, we explored potential predictors of adequate pain management. Methods: This observational, prospective, multicenter cohort study included cancer patients aged 18 years or older who were referred to RT departments. A pain management assessment was conducted using the Pain Management Index (PMI), calculated by subtracting the pain score from the analgesic score (PMI < 0 indicated inadequate pain management). Univariate and multivariate analyses were performed to identify predictors of adequate pain management. Results: A total of 1042 cancer outpatients were included in the study. The analysis revealed that 42.9% of patients with pain did not receive adequate pain management based on PMI values. Among patients with pain or taking analgesics and referred to palliative or curative RT, 72% and 75% had inadequate or ineffective analgesic therapy, respectively. The odds of receiving adequate pain management (PMI ≥ 0) were higher in patients undergoing palliative RT (OR 2.52; p < 0.001), with worse ECOG-PS scores of 2, 3 and 4 (OR 1.63, 2.23, 5.31, respectively; p: 0.017, 0.002, 0.009, respectively) compared to a score of 1 for those with cancer-related pain (OR 0.38; p < 0.001), and treated in northern Italy compared to central and southern of Italy (OR 0.25, 0.42, respectively; p < 0.001). Conclusions: In this study, a substantial proportion of cancer patients referred to RT departments did not receive adequate pain management. Educational and organizational strategies are necessary to address the inadequate pain management observed in this population. Moreover, increasing the attention paid to non-cancer pain and an earlier referral of patients for palliative RT in the course of the disease may improve pain response and treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Adequacy of Pain Management in Patients Referred for Radiation Therapy: A Subanalysis of the Multicenter ARISE-1 Study

Donati,

Maggiore,

Maltoni

et al. 2023

Cancers

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“…In this case, the patients are most frequently metastatic and the objective of the treatment is to treat a symptom. The doses are often much lower, typically 30 Gy in 10 fractions or 20 Gy in 5 fractions [31]. Examples are irradiation of bone metastases for analgesic purposes [32], whole brain irradiation when patients have brain metastases and a risk of intracranial hypertension [33,34], mediastinal irradiation when patients have compressive mediastinal tumors [35], and irradiation for hemostatic purposes when patients have very hemorrhagic tumors [36].…”

Section: Irradiation With Palliative Intentmentioning

confidence: 99%

A Comprehensive Primer on Radiation Oncology for Non-Radiation Oncologists

Beddok,

Lim,

Thariat

et al. 2023

Cancers

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Background: Multidisciplinary management is crucial in cancer diagnosis and treatment. Multidisciplinary teams include specialists in surgery, medical therapies, and radiation therapy (RT), each playing unique roles in oncology care. One significant aspect is RT, guided by radiation oncologists (ROs). This paper serves as a detailed primer for non-oncologists, medical students, or non-clinical investigators, educating them on contemporary RT practices. Methods: This report follows the process of RT planning and execution. Starting from the decision-making in multidisciplinary teams to the completion of RT and subsequent patient follow-up, it aims to offer non-oncologists an understanding of the RO’s work in a comprehensive manner. Results: The first step in RT is a planning session that includes obtaining a CT scan of the area to be treated, known as the CT simulation. The patients are imaged in the exact position in which they will receive treatment. The second step, which is the primary source of uncertainty, involves the delineation of treatment targets and organs at risk (OAR). The objective is to ensure precise irradiation of the target volume while sparing the OARs as much as possible. Various radiation modalities, such as external beam therapy with electrons, photons, or particles (including protons and carbon ions), as well as brachytherapy, are utilized. Within these modalities, several techniques, such as three-dimensional conformal RT, intensity-modulated RT, volumetric modulated arc therapy, scattering beam proton therapy, and intensity-modulated proton therapy, are employed to achieve optimal treatment outcomes. The RT plan development is an iterative process involving medical physicists, dosimetrists, and ROs. The complexity and time required vary, ranging from an hour to a week. Once approved, RT begins, with image-guided RT being standard practice for patient alignment. The RO manages acute toxicities during treatment and prepares a summary upon completion. There is a considerable variance in practices, with some ROs offering lifelong follow-up and managing potential late effects of treatment. Conclusions: Comprehension of RT clinical effects by non-oncologists providers significantly elevates long-term patient care quality. Hence, educating non-oncologists enhances care for RT patients, underlining this report’s importance.

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“…Among factors to consider are an intervention’s aim, e.g., life-prolonging versus symptom-directed, and time-frame aspects such as remaining life time and duration of treatment. Palliative radiotherapy is among the most effective and cost-effective interventions and can be tailored to individual patients’ need and preferences [ 2 – 5 ]. Extreme hypofractionation cuts treatment duration into a fraction of what is needed to complete traditional regimens, e.g.…”

Section: Introductionmentioning

confidence: 99%

Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

et al. 2023

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Background This study analyzed mortality after radiotherapy for bone metastases (287 courses). Endpoints such as treatment in the last month of life and death within 30, 35 and 40 days from start of radiotherapy were evaluated. Methods Different baseline parameters including but not limited to blood test results and patterns of metastases were assessed for association with early death. After univariate analyses, multi-nominal logistic regression was employed. Results Of 287 treatment courses, 42 (15%) took place in the last month of life. Mortality from start of radiotherapy was 13% (30-day), 15% (35-day) and 18% (40-day), respectively. We identified three significant predictors of 30-day mortality (performance status (≤ 50, 60–70, 80–100), weight loss of at least 10% within 6 months (yes/no), pleural effusion (present/absent)) and employed these to construct a predictive model with 5 strata and mortality rates of 0–75%. All predictors of 30-day mortality were also associated with both, 35- and 40-day mortality. Conclusion Early death was not limited to the first 30 days after start of radiotherapy. For different cut-off points, similar predictive factors emerged. A model based on three robust predictors was developed.

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Short course palliative radiotherapy in advanced solid tumors: a pooled analysis (the SHARON project)

Cited by 5 publications

References 21 publications

Adequacy of Pain Management in Patients Referred for Radiation Therapy: A Subanalysis of the Multicenter ARISE-1 Study

Adequacy of Pain Management in Patients Referred for Radiation Therapy: A Subanalysis of the Multicenter ARISE-1 Study

A Comprehensive Primer on Radiation Oncology for Non-Radiation Oncologists

Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

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