Treatment of Solitary Painful Osseous Metastases with Radiotherapy, Cryoablation or Combined Therapy: Propensity Matching Analysis in 175 Patients

Abstract

Purposeaim of this study was to identify outcomes in pain relief and quality of life in patients with a solitary painful osseous metastasis treated by radiotherapy, cryoablation or the combination using a propensity score matching study design.Materials and Methods175 patients with painful bone metastases were included in the study. Twenty-five of them underwent a radiation course (20 Gy in five daily fractions) 15 days after the cryoablation. These subjects were retrospectively matched by propensity analysis with a group of subjects treated by radiotherapy (125 subjects) and with a group treated byCryoablation (25 subjects). The pain relief in terms of complete response, rate of subjects requiring analgesics after treatments and the changes in self-rated quality of life were measured. Informed consent was obtained from the subject and the study was approved by the local Ethical Committee.ResultsAn higher proportion of subjects treated by cryoablation (32%) or cryoablation followed by RT (72%;) experienced a complete response compared with patients treated by radiotherapy alone (11.2%). After Bonferroni correction strategy, the addition of radiotherapy to cryoablation significantly improved the rate of complete response compared with cryoablation alone (p = 0.011) and this paralleled with an improved self-rated quality of life. Seventeen subjects (13.6%) of patients in the radiotherapy group, 9 (36%) in the cryoablation group, and 19 (76)% in the cryoablation- radiotherapy group did not require narcotic medications.ConclusionsThe addition of radiotherapy to cryoablation favorably impacts on perceived pain, with a favorable toxicity profile. However, our data should be interpreted with caution and could serve as a framework around which to design future trials.

Efficacy of Cryoablation to Control Cancer Pain: A Systematic Review

“…Thacker et al . and Di Staso et al . reported decreases of 38% at 24 hours and 36% at 12 weeks, respectively, although these were not statistically significant.…”

“…reported similar findings, with pain interference on the BADL score decreasing by nearly 60% (statistical significance not specified). In 2015, Di Staso et al . also reported significant improvements in BADL scores.…”

“…Some studies assessed pain relief as function of opioid needs assessed as the morphine‐equivalent 24‐hour dose. In 5 of 22 articles, multiple scales were used to assess response …”

“…Di Staso et al . assessed pain control at 12 weeks, finding a CR (defined as 0/10 on the pain scale without any increase in opioid doses) in 32% of subjects, a partial response (PR; decrease of ≥2/10) in 36%, and stability or worsening (increase of > 2/10 on the pain scale) in 16%.…”

“…Opioid requirements were assessed in 6 studies, all of which demonstrated a reduction in opioid requirements. However, only Prologo et al .…”