Efficacy of 8 Gy Single Fraction Palliative Radiation Therapy in Painful Bone Metastases: A Single Institution Experience

Shuja, Muhammad; Elghazaly, Ayman A; Iqbal, Asif; Mohamed, Reham A.; Marie, Amal; Tunio, Mutahir A.; Aly, Moamen M.O.M.; Balbaid, Ali Abdullah O; Asiri, Mushabbab Al

doi:10.7759/cureus.2036

Cited by 10 publications

(8 citation statements)

References 19 publications

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“…While several randomized single fraction vs. multiple fraction trials have been carried out, the concerns of toxicities and efficacy of the 8 Gy in 1 fraction regimen still remain. Shuja et al and Howell et al described utilization of 3–5 cm margin and <2 cm margin, respectively, from the radiographic involvement for single fraction palliative radiotherapy on conventional c-arm linac modalities (29, 30). The superior bony metastasis visualization combined with improved soft tissue visualization allow for greater precision and enable the utility of a reduced margin in MRgRT of 0.3–0.5 cm as previously demonstrated by Mittauer et al (16).…”

Section: Discussionmentioning

confidence: 99%

STAT-ART: The Promise and Practice of a Rapid Palliative Single Session of MR-Guided Online Adaptive Radiotherapy (ART)

et al. 2019

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This work describes a novel application of MR-guided online adaptive radiotherapy (MRgoART) in the management of patients whom urgent palliative care is indicated using statum-adaptive radiotherapy (STAT-ART). The implementation of STAT-ART, as performed at our institution, is presented including a discussion of the advantages and limitations compared to the standard of care for palliative radiotherapy on conventional c-arm linacs. MR-based treatment planning techniques of STAT-ART for density overrides and deformable image registration (DIR) of diagnostic CT to the treatment MR are also addressed.

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Section: Discussionmentioning

confidence: 99%

STAT-ART: The Promise and Practice of a Rapid Palliative Single Session of MR-Guided Online Adaptive Radiotherapy (ART)

et al. 2019

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“…The total dosage of cEBRT can vary depending on the size and type of the primary tumor with typical dosages of 25–40 Gy divided into 8–20 fractions [ 96 ]. The standard of care for pain relief in noncomplicated spine metastasis is a single-fraction radiotherapy with a dose of 8 Gy [ 97 , 98 , 99 ]. Single-fraction regimens are cost effective and practical when radiation treatment facilities are limited [ 99 ].…”

Section: Metastasismentioning

confidence: 99%

“…The standard of care for pain relief in noncomplicated spine metastasis is a single-fraction radiotherapy with a dose of 8 Gy [ 97 , 98 , 99 ]. Single-fraction regimens are cost effective and practical when radiation treatment facilities are limited [ 99 ]. However, the benefits of single-fraction radiation need to be weighed with an increased chance of retreatment compared to a multifraction regimen [ 94 ].…”

Section: Metastasismentioning

confidence: 99%

Characterization and Treatment of Spinal Tumors

2022

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The prevalence of spinal tumors is rare in comparison to brain tumors which encompass most central nervous system tumors. Tumors of the spine can be divided into primary and metastatic tumors with the latter being the most common presentation. Primary tumors are subdivided based on their location on the spinal column and in the spinal cord into intramedullary, intradural extramedullary, and primary bone tumors. Back pain is a common presentation in spine cancer patients; however, other radicular pain may be present. Magnetic resonance imaging (MRI) is the imaging modality of choice for intradural extramedullary and intramedullary tumors. Plain radiographs are used in the initial diagnosis of primary bone tumors while Computed tomography (CT) and MRI may often be necessary for further characterization. Complete surgical resection is the treatment of choice for spinal tumors and may be curative for well circumscribed lesions. However, intralesional resection along with adjuvant radiation and chemotherapy can be indicated for patients that would experience increased morbidity from damage to nearby neurological structures caused by resection with wide margins. Even with the current treatment options, the prognosis for aggressive spinal cancer remains poor. Advances in novel treatments including molecular targeting, immunotherapy and stem cell therapy provide the potential for greater control of malignant and metastatic tumors of the spine.

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“…However, the optimal radiation dose, fractionation regimen and treatment time remains controversial. Currently, there is increasing interest in resource sparing single fraction of 8 Gy in one fraction for palliating painful spine metastasis [4,5]. Many randomized trials have reported that single fraction of 8 Gy is equivalent to higher radiation doses (20 Gy in 5 fractions or 30 Gy in 10 fractions) [6,7].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of two Palliative Radiotherapy Regimens (20 Gy in five fractions versus 8 Gy in one fraction) for Thoracic Spine Bone metastases. Experience of Saudi Arabia

2021

SECI Oncology Journal

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Background:In spite of wider use of 8 Gy in one fraction palliative radiotherapy regimen for bone metastases in the Western world, data is scantly in the Middle East. We aimed to compare a single dose of 8 Gy vs. 20 Gy in 5 fractions for thoracic spine metastases. Materials and methods:Forty patients with metastatic breast, prostate and lung cancers were randomized to receive a single dose of 8 Gy (n =20) vs. 20 Gy in 5 fractions (n =20) for thoracic spine metastases. Relief of pain and intensity was assessed prospectively via a pain questionnaire prior to treatment and every 4 weeks thereafter, using a 4-point scale (none, mild, moderate, severe), along with need for types of analgesic drugs and doses taken.Results: Complete pain relief was achieved in 9 patients (45%) treated with one fraction of 8 Gy and in 11 patients (55%) who received 20 Gy in 5 fractions (P=0.61). Similarly, no difference between the two treatment regimens according to duration of pain relief (medians of 9 and 9.5 months, respectively) P = 0.42. No difference in nausea and vomiting (N&V) was seen (5 patients in 20 Gy in 5 fractions vs.7 patients in 8 Gy in one fraction), However, N&V was significantly prolonged in patients who received 8 Gy in one fractions (15 days vs. 7 days in 20 Gy in 5 fractions) P =0.03. Conclusions:No difference in pain relief and duration was noticed between two palliative radiotherapy regimens (8 Gy in one fraction vs. 20 Gy in 5 fractions) for painful thoracic spine metastases, however, nausea and emesis was prolonged with single fraction of 8 Gy, which warrants further larger trials of 8 Gy in single fractions in painful thoracic spine metastases.

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Efficacy of 8 Gy Single Fraction Palliative Radiation Therapy in Painful Bone Metastases: A Single Institution Experience

Cited by 10 publications

References 19 publications

STAT-ART: The Promise and Practice of a Rapid Palliative Single Session of MR-Guided Online Adaptive Radiotherapy (ART)

STAT-ART: The Promise and Practice of a Rapid Palliative Single Session of MR-Guided Online Adaptive Radiotherapy (ART)

Characterization and Treatment of Spinal Tumors

Effectiveness of two Palliative Radiotherapy Regimens (20 Gy in five fractions versus 8 Gy in one fraction) for Thoracic Spine Bone metastases. Experience of Saudi Arabia

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