Early evaluation predicts pain relief of irradiated bone metastases: a single-center prospective study

Abstract

BackgroundRadiation therapy is a well-recognized, effective modality used for palliative care. Most studies completed to date have endpoints of one month or greater after treatment completion. This study analyzed the response rates at different time points during the first month after treatment.MethodsFrom May 2010 to November 2011, 61 patients treated for 74 metastases were included in the study. The end points were defined as the completion of treatment (CT) and d8, d15 and d30 after the completion of treatment. The response rate was measured by the worst pain in the last 24 hours and the administered opioid dose. Patient assessment was performed during consultations and phone appointments.ResultsThe overall response rate significantly improved from the CT (38%) to d8 (53.8%), d15 (53.8%) and d30 (57.1%) (respectively p < 0.001; p < 0.001 and p = 0.001). The improvement peaked at d8. Patients responding to the treatment at d8 had a significative longer pain relapse free survival (PRFS) compared to patients not responding (3.38 weeks vs 0.3 weeks; p < 0.001). From the beginning of treatment to the CT and at d8 , d15 and d30, oral morphine equivalent dose (OMED) did not significantly differ. However, the pain decrease did not result in a performance status improvement, which declined over time (p < 0.001).ConclusionRadiation therapy is an efficient treatment method for providing pain relief. This relief peaked at d8 after treatment, and the response at d8 is predictive of the response at 4 weeks. Pain management alone is not enough to improve performance status; further studies are needed to evaluate a more global supportive care approach.

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

“…The high prevalence of bone metastases imposes a substantial socioeconomic burden, which attracts the attention of governments, pharmaceutical companies, academic researchers and other healthcare payers. More recent RCTs and non-RCTs have demonstrated the potential benefits of certain dose fractionations of palliative radiotherapy 6 11 44–47. However, the results of publications focusing on palliative radiotherapy in patients with bone metastases varied significantly for study designs and varying outcomes of interest, especially for different dose-fractionation schedule.…”

Interaction of antihistaminic drugs with human translationally controlled tumor protein (TCTP) as novel approach for differentiation therapy

“…The bioavailability of levomepromazine per os is 20-40% (up to 30 μM). The maximal serum concentrations are achieved within 1-3 h after oral administration [ 63 , 64 ]. The excretion is slow with a half-life of 15-30 h [ 63 ].…”

“…These concentrations comprise the range of achievable clinical concentrations. The IC 50 value of levomepromazine was 12.21 μM, which represents a concentration reachable in blood plasma [ 63 , 64 ]. However, the IC 50 value of buclizine was 19.18 μM and it is higher than maximal buclizine concentration in plasma [ 68 ].…”

An investigation into the incidence of pain flare in patients undergoing radiotherapy for symptomatic bone metastases

“…In particular, bone metastases are a frequently occurring complication of many cancers, predominantly breast, prostate and lung, and are known to be experienced by approximately 70% of patients 2 . These can lead to poor quality of life (QoL), with patients experiencing many symptoms, including pathological fractures, hypercalcaemia and metastatic spinal cord compression (MSCC), some of which may require surgical intervention [3][4][5] . The main systemic management options for bone cancer are SACT (including bisphosphonates), surgery, chemotherapy and hormone manipulation, supported by analgesia.…”