Update of the systematic review of palliative radiation therapy fractionation for bone metastases

Rich, Shayna E.; Chow, Ronald; Raman, Srinivas; Zeng, Kang; Lutz, S; Lam, Henry; Silva, Maurício F.; Chow, Edward

doi:10.1016/j.radonc.2018.01.003

Cited by 201 publications

(162 citation statements)

References 54 publications

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“…These values are lower than the overall response rates of 72% to 75% and complete response rates of 28% to 29% reported in RCTs. 2 Four factors may have contributed to the differences in response rates in evaluable patients between RCTs and nonrandomized studies. First, the differing definitions of pain responses may partially explain the results of the present review.…”

Section: Discussionmentioning

confidence: 99%

“…1 In previous randomized controlled trials (RCTs), 72% to 75% of evaluable patients and 61% to 62% of intent-to-treat patients were reported to have experienced pain response after RT. 2 Compared with the rates found in RCTs, the pain response rates after RT for bone metastases found in nonrandomized studies are less known. Patients enrolled in RCTs and nonrandomized studies are from different populations, and RCTs and nonrandomized studies yield differing conclusions regarding treatment efficacy, even after adjusting for known prognostic factors.…”

Section: Introductionmentioning

confidence: 99%

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Pain Response Rates After Conventional Radiation Therapy for Bone Metastases in Prospective Nonrandomized Studies: A Systematic Review

Saitô

Toya

Oya

2019

Practical Radiation Oncology

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This study aimed to determine the pain response rates after conventional radiation therapy (RT) for painful bone metastases in prospective nonrandomized studies, which better reflect daily practice than randomized controlled trials. Methods and materials: A literature search was conducted in PubMed and Scopus for articles published between 2002 and 2018. We only included articles in which pain response after RT was assessed using the International Consensus Endpoint initially published in 2002, or the updated version from 2012. In addition, to be included in this review, the study design was required to be prospective or based on prospectively collected data. Our primary outcomes of interest were the overall and complete response rates after conventional RT for bone metastases. Results: Of the 2863 articles identified in our database search, 12 met the inclusion criteria. Six studies excluded patients with features of complicated bone metastases. Only 2 papers reported exclusion criteria regarding analgesic use. Radiation schedules that were frequently used were 1 Â 8 Gy, 5 Â 4 Gy, and 10 Â 3 Gy. The overall response rate in evaluable patients was 55%, and 754 of the 1379 evaluable patients experienced a complete or partial response. The complete response rate was 15% (196 of 1348 evaluable patients). In the intent-to-treat patient group, the overall response rate was 29% (754 of 2559 enrolled patients), and the complete response rate 8% (196 of 2528 enrolled patients). Conclusions: We determined the pain response rates after conventional RT for painful bone metastases in prospective nonrandomized studies. The present review may provide benchmarks for future nonrandomized studies that investigate palliative RT for bone metastases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pain Response Rates After Conventional Radiation Therapy for Bone Metastases in Prospective Nonrandomized Studies: A Systematic Review

Saitô

Toya

Oya

2019

Practical Radiation Oncology

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“…Ratanatharathorn et al found that higher dose fractionated radiotherapy produced better outcomes in pain control, in terms of frequency, duration and magnitude, than low-dose regimens 10. However, the majority of meta-analyses produced the opposite results suggesting that the differences between single fraction and multiple fraction radiation treatment regimens were small and non-significant 11–16…”

Section: Introductionmentioning

confidence: 99%

Optimal dose-fractionation schedule of palliative radiotherapy for patients with bone metastases: a protocol for systematic review and network meta-analysis

Tang

Chen

et al. 2020

BMJ Open

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IntroductionThe optimal dose-fractionation schedule of palliative radiotherapy has been debated in patients with bone metastases. Our objective is to comprehensively compare multiple fraction schedules with single fraction radiotherapy in terms of efficacy and toxicities by performing a systematic review and network meta-analysis.Methods and analysisElectronic searches of titles/abstracts of palliative radiotherapy for bone metastases will be performed, using PubMed, Cochrane Library, Embase,clinical trials, American Society for Therapeutic Radiology and Oncology and European Society of Radiotherapy and Oncology. The primary outcome of interest is the incidence of skeletal-related event following palliative radiotherapy for bone metastases in prospective studies. The risk of bias and quality of evidence will be evaluated based on Cochrane Collaboration’s tool and Grades of Recommendation, Assessment, Development and Evaluation in the network meta-analysis. We will conduct subgroup analysis and sensitivity analysis regardless of heterogeneity estimates.Ethics and disseminationThis study will synthesise the evidence regarding dose-fractionation schedule of palliative radiotherapy in patients with bone metastases. We hope the findings from this study will help clinicians and patients select optimum palliative radiotherapy by identifying the optimal dose-fractionation schedule of palliative radiotherapy with the most value in terms of patient-important outcomes. The evidence obtained from network meta-analysis will help to guide head-to-head research in the future. The results will be disseminated through international conference reports and peer-reviewed manuscripts. Ethics review board is not required for this network meta-analysis.PROSPERO registration numberCRD42019135195.

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“…These symptoms negatively affect the patient's quality of life (QOL) and diminish performance status (PS). Radiation therapy (RT) is recognized as a highly effective standard therapy for BMs providing pain relief in approximately 60-80% patients as per the evidence from randomized trials [4], with slightly lower response rates (55%) as per the real-world evidence [5].…”

Section: Introductionmentioning

confidence: 99%

Practice Patterns for Postoperative Radiation Therapy in Patients with Metastases to the Long Bones: Survey of the Japanese Radiation Oncology Study Group

Kubota

Nakamura

Shikama

et al. 2020

Preprint

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BackgroundBecause of the lack of evidence on practice patterns of postoperative radiation therapy (PORT)in patients with metastases to the long bones, it is essential to characterize the current practice patterns and identify factors affecting dose-fractionation to aid future clinical trials. MethodsThe palliative radiation therapy subgroup of the Japanese Radiation Oncology Study Group conducted an internet-based survey to determine the prescription practices and various dose-fractionations used for PORT. Additionally, responders were asked to recommend dose-fractionations in four hypothetical cancer cases, wherein each case represented a patient with impending pathological fractures and one of the four features: limited prognosis, solitary metastasis, radio-resistant primary tumor, or long-term survival. Responders were asked to indicate their preferred irradiation fields and the reasons for choosing long-course radiotherapy over short-course radiotherapy (RT). ResultsEighty-nine radiation oncologists from 67 institutions and 151 RT plans were included. Twenty-two different dose-fractionations were used; the most commonly used and recommended dose-fractionation was 30 Gy in 10 fractions. “Local control” was most the common reason for preferring longer course RT. While fractionated higher-dose regimens were preferred in case of oligometastasis, low dose regimens were preferred in case of limited prognosis; single fraction RT was never preferred. Most respondents recommended involvement of “the entire orthopedic prosthesis.” ConclusionFor PORT of metastases to the long bones, 30 Gy in 10 fractions for the entire orthopedic prosthesis is preferred in current practice. Oligometastasis and a limited prognosis influence the selection of high- and low-dose regimens, respectively. Single fraction RT is never preferred.

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Update of the systematic review of palliative radiation therapy fractionation for bone metastases

Cited by 201 publications

References 54 publications

Pain Response Rates After Conventional Radiation Therapy for Bone Metastases in Prospective Nonrandomized Studies: A Systematic Review

Pain Response Rates After Conventional Radiation Therapy for Bone Metastases in Prospective Nonrandomized Studies: A Systematic Review

Optimal dose-fractionation schedule of palliative radiotherapy for patients with bone metastases: a protocol for systematic review and network meta-analysis

Practice Patterns for Postoperative Radiation Therapy in Patients with Metastases to the Long Bones: Survey of the Japanese Radiation Oncology Study Group

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