ESTRO ACROP guidelines for external beam radiotherapy of patients with uncomplicated bone metastases

Velden, Joanne Van der; Willmann, Jonas; Spałek, Mateusz; Oldenburger, Eva; Brown, Stephanie; Kaźmierska, Joanna; Andratschke, Nicolaus; Menten, Johan; Linden, Y. van der; Hoskin, Peter

doi:10.1016/j.radonc.2022.05.024

Cited by 49 publications

(37 citation statements)

References 88 publications

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“…Radiotherapy is a well-established and non-invasive local treatment modality for bone metastasis. For patients with a short prognosis, it is recommended to use 8 Gy in single fraction (biologically effective dose [BED 10 , BED calculated using an α/β of 10 Gy] = 14.4 Gy) external beam radiotherapy (RT) as palliative treatment to provide pain relief [ 6 , 7 , 8 ]. For the pain without pathological fractures or spinal cord compression, RT of 8 Gy in single fraction can provide the comparable effect of pain relief to 30 Gy in 10 fraction or 20 Gy in 5 fractions [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Survival and Local Control in Patients with Bone Metastases Treated with Radiotherapy

et al. 2023

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The aim of this study was to evaluate the expected prognosis and factors affecting local control (LC) of the bone metastatic sites treated with palliative external beam radiotherapy (RT). Between December 2010 and April 2019, 420 cases (male/female = 240/180; median age [range]: 66 [12–90] years) with predominantly osteolytic bone metastases received RT and were evaluated. LC was evaluated by follow-up computed tomography (CT) image. Median RT doses (BED10) were 39.0 Gy (range, 14.4–71.7 Gy). The 0.5-year overall survival and LC of RT sites were 71% and 84%, respectively. Local recurrence on CT images was observed in 19% (n = 80) of the RT sites, and the median recurrence time was 3.5 months (range, 1–106 months). In univariate analysis, abnormal laboratory data before RT (platelet count, serum albumin, total bilirubin, lactate dehydrogenase, or serum calcium level), high-risk primary tumor sites (colorectal, esophageal, hepatobiliary/pancreatic, renal/ureter, and non-epithelial cancers), no antineoplastic agents (ATs) administration after RT, and no bone modifying agents (BMAs) administration after RT were significantly unfavorable factors for both survival and LC of RT sites. Sex (male), performance status (≥3), and RT dose (BED10) (<39.0 Gy) were significantly unfavorable factors for only survival, and age (≥70 years) and bone cortex destruction were significantly unfavorable factors for only LC of RT sites. In multivariate analysis, only abnormal laboratory data before RT influenced both unfavorable survival and LC of RT sites. Performance status (≥3), no ATs administration after RT, RT dose (BED10) (<39.0 Gy), and sex (male) were significantly unfavorable factors for survival, and primary tumor sites and BMAs administration after RT were significantly unfavorable factors for LC of RT sites. In conclusion, laboratory data before RT was important factor both prognosis and LC of bone metastases treated with palliative RT. At least in patients with abnormal laboratory data before RT, palliative RT seemed to be focused on the only pain relief.

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Section: Introductionmentioning

confidence: 99%

Factors Affecting Survival and Local Control in Patients with Bone Metastases Treated with Radiotherapy

et al. 2023

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“…Importantly, single-fraction radiotherapy with 8 Gy results in similar overall response rates compared to multi-fraction radiotherapy (72% vs. 75% among assessable patients in the updated meta-analysis of Rich et al [ 32 ]) and is therefore especially convenient for patients with limited life expectance [ 7 , 32 ]. According to the current ESTRO ACROP guideline, single-fraction radiotherapy with 8 Gy is the preferred radiotherapy schedule for uncomplicated bone metastases [ 39 ]. The re-irradiation rate in our study was relatively low (2.4% of treated patients) which may be related to the high proportion of patients receiving long-course radiotherapy, although other factors related to this special patient population (e.g., refusal of re-irradiation due to reduced performance status or impaired patient mobility) may also have contributed to this result, so that definitive conclusions based on our analysis are not possible.…”

Section: Discussionmentioning

confidence: 99%

“…In light of the high compliance rate and the relatively long survival time of patients with an ECOG status of 0 (median OS = 24 months) in our octogenarian cohort, long-course radiotherapy courses with focal dose escalation using simultaneous integrated boost concepts may increase the chance of long-term local control in these patients [ 40 – 43 ]. However, radiotherapy schedules with simultaneous integrated boosts are no standard treatments according to the current guidelines and require further prospective evidence [ 39 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Palliative radiotherapy of bone metastases in octogenarians: How do the oldest olds respond? Results from a tertiary cancer center with 288 treated patients

et al. 2022

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Background Accompanied by the demographic change, the number of octogenarian cancer patients with bone metastases will increase in the future. Palliative radiotherapy constitutes an effective analgesic treatment; however, as pain perception and bone metabolism change with increasing age, the analgesic efficacy of radiotherapy may be altered in elderly patients. We therefore investigated the treatment outcomes of palliative radiotherapy for bone metastases in octogenarians. Methods Patients between 80 and 89 years undergoing radiotherapy for bone metastases between 2009 and 2019 at a tertiary cancer center were analyzed for patterns-of-care, pain response and overall survival (OS). Logistic regression analyses were carried out to examine parameters associated with pain response, and Cox analyses were conducted to reveal prognostic parameters for OS. Results A total of 288 patients with 516 irradiated lesions were included in the analysis. The majority (n = 249, 86%) completed all courses of radiotherapy. Radiotherapy led to pain reduction in 176 patients (61%) at the end of treatment. Complete pain relief at the first follow-up was achieved in 84 patients (29%). Bisphosphonate administration was significantly associated with higher rates of pain response at the first follow-up (p < 0.05). Median OS amounted to 9 months, and 1-year, 2-year and 3-year OS were 43%, 28% and 17%. In the multivariate analysis, ECOG (p < 0.001), Mizumoto score (p < 0.01) and Spinal Instability Neoplastic Score (SINS) (p < 0.001) were independent prognosticators for OS. Conclusion Palliative radiotherapy for bone metastases constitutes a feasible and effective analgesic treatment in octogenarian patients. ECOG, Mizumoto score and SINS are prognosic variables for survival and may aid treatment decisions regarding radiotherapy fractionation in this patient group. Single-fraction radiotherapy with 8 Gy should be applied for patients with uncomplicated bone metastases and poor prognosis. Prospective trials focusing on quality of life of these very old cancer patients with bone metastases are warranted to reveal the optimal radiotherapeutic management for this vulnerable population.

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“…These guidelines were printed in two issues following clinical dichotomization into complicated and uncomplicated metastases that require altered treatment. Complicated metastases (one third of the cases) comprise cases that involve spinal fractures, focal neurological deficits, or an associated soft tissue mass that cause spinal cord or cauda equina compression [ 265 , 266 , 267 ].…”

Section: Radiotherapymentioning

confidence: 99%

“…The guidelines also address the issue of respective techniques implied in palliative pain treatment; however, due to lack of high-level evidence regarding superiority of one over another to date, each approach should be considered on the individual basis. However, the authors recommend 3D conformal image-guided radiotherapy for uncomplicated bone metastases and clinical target volume (CTV)-based RT in the event of soft tissue mass involved [ 266 ].…”

Section: Radiotherapymentioning

confidence: 99%

Biological and Clinical Aspects of Metastatic Spinal Tumors

Litak

Czyżewski

Szymoniuk

et al. 2022

Cancers

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Spine metastases are a common life-threatening complication of advanced-stage malignancies and often result in poor prognosis. Symptomatic spine metastases develop in the course of about 10% of malignant neoplasms. Therefore, it is essential for contemporary medicine to understand metastatic processes in order to find appropriate, targeted therapeutic options. Thanks to continuous research, there appears more and more detailed knowledge about cancer and metastasis, but these transformations are extremely complicated, e.g., due to the complexity of reactions, the variety of places where they occur, or the participation of both tumor cells and host cells in these transitions. The right target points in tumor metastasis mechanisms are still being researched; that will help us in the proper diagnosis as well as in finding the right treatment. In this literature review, we described the current knowledge about the molecular pathways and biomarkers engaged in metastatic processes involving the spine. We also presented a current bone-targeted treatment for spine metastases and the emerging therapies targeting the discussed molecular mechanisms.

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ESTRO ACROP guidelines for external beam radiotherapy of patients with uncomplicated bone metastases

Cited by 49 publications

References 88 publications

Factors Affecting Survival and Local Control in Patients with Bone Metastases Treated with Radiotherapy

Factors Affecting Survival and Local Control in Patients with Bone Metastases Treated with Radiotherapy

Palliative radiotherapy of bone metastases in octogenarians: How do the oldest olds respond? Results from a tertiary cancer center with 288 treated patients

Biological and Clinical Aspects of Metastatic Spinal Tumors

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