Effectiveness and toxicity of conventional radiotherapy treatment for painful spinal metastases: a detailed course of side effects after opposing fields versus a single posterior field technique

Abstract

BackgroundConventional radiotherapy for painful spinal metastases can be delivered with a single posterior-anterior (PA) or two opposed anterior-posterior (APPA) fields. We studied the effectiveness and toxicity of both techniques and studied whether treatment technique was predictive for abdominal and skin toxicity.Patients and methodsWithin the Dutch Bone Metastasis Study, 343 patients received 8 Gray in a single fraction or 24 Gray in six fractions for painful spinal metastases. Treatment technique was not randomized. At baseline and weekly during follow-up, patients reported pain and other physical complaints. Any complaint increasing within 4 weeks after treatment was noted as a side effect. Pain response was calculated according to international standards, taking into account changes in pain score and medication. Repeated measurement analyses and multivariate logistic analyses were performed.ResultsPatients were mainly treated on the thoracic (34%) and lumbar (53%) spine and 73% received a PA field. Pain response was similar between both techniques (74%). In patients treated at the thoraco-lumbar and lumbar spine, with multiple fractions, significantly more abdominal complaints were noticed. In multivariate analysis, radiotherapy technique did not predict for side effects.ConclusionConventional radiotherapy of painful spinal metastases provides limited toxicity. Radiotherapy technique is not an independent predictor of abdominal and skin toxicity of irradiation.

Patient satisfaction with treatment outcomes after surgery and/or radiotherapy for spinal metastases

“…13 The reported incidence of adverse events with radiotherapy is similar, yet the adverse event profile is substantially less severe in comparison with surgical adverse events. 14 In the current study, posttreatment adverse events were reported in 33% of the surgically treated patients and in 12% of the radiotherapy patients. The occurrence of an adverse event, with the exception of the occurrence of an intraoperative adverse event, was in neither of the groups associated with dissatisfaction after treatment.…”

“…Surgery for spinal metastases is, despite the advances in surgical techniques, often invasive surgery as reflected by reported adverse event rates of up to 76% . The reported incidence of adverse events with radiotherapy is similar, yet the adverse event profile is substantially less severe in comparison with surgical adverse events . In the current study, posttreatment adverse events were reported in 33% of the surgically treated patients and in 12% of the radiotherapy patients.…”

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“…An optimal radiotherapy regimen palliates symptom with minimal toxicity. In general, the published data regarding toxicity, reveals that treatment was well tolerated [16][17][18].…”

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“…It is therefore that a combined immune therapy and directed to the EMT, would lead to decrease the robustness of the system and consequently to increase the efficacy in the treatment of tumors in advanced phase. Resistance to therapeutic regimens is a key problem for cancer therapy, as it precludes complete remove of the tumour and enables tumour recurrence, which is one of the main causes of death [10,41] .…”