Incidence of pain flare following palliative radiotherapy for symptomatic bone metastases: multicenter prospective observational study

Abstract

BackgroundPalliative radiotherapy (RT) is an effective treatment for symptomatic bone metastases. Pain flare, a transient worsening of the bone pain after RT, has been described in previous reports with different incidence rates. The aim of the study was to prospectively evaluate the incidence of pain flare following RT for painful bone metastases and evaluate its effects on pain control and functionality of the patients.MethodsBetween June 2010 and June 2014, 204 patients were enrolled in this study and 135 patients with complete data were evaluable. Pain flare was defined as a 2- point increase in worst pain score as compared with baseline with no decrease in analgesic intake or a 25 % increase in analgesic intake as compared with baseline with no decrease in worst pain score. All pain medications and worst pain scores were collected before, daily during, and for 10 days after RT. The Brief Pain Inventory (BPI) was filled out on the pretreatment and at the 4 weeks follow-up visit.ResultsThere were 90 men (66.7 %) and 45 women (33.3 %). Mean age was 66 years (SD 9.8). The most common primary cancer site was lung in 42 patients (31.1 %), followed by prostate in 27 patients (20.0 %). Forty-two patients (31.1 %) patients received a single fraction of 8 Gy and 83 (61.5 %) received 20 Gy in five fractions.The overall pain flare incidence across all centers was 51/135 (37.7 %). The majority of pain flares occurred on days 1–5 (88.2 %). The mean duration of the pain flare was 3 days (SD: 3). There were no significant relationships between the occurrence of pain flare and collected variables.All BPI items measured four weeks after end of RT showed significant improvement as compared with pretreatment scores (p < 0.001). No significant differences in BPI time trends were found between patients with and without flare pain.ConclusionPain flare is a common event, occurring in nearly 40 % of the patients that receive palliative RT for symptomatic bone metastases. This phenomenon is not a predictor for pain response.

Pain flare, complexity and analgesia in bone oligometastases treated with stereotactic body radiation therapy

“…Pain flare was a frequent side effect of SBRT and was found in more than one third of patients in our series. The occurrence of pain flare is a common acute adverse effect in patients treated with CRT palliative dose schedules, with reported incidence up to 40% (Chow et al, ; Loblaw, Wu, Panzarella, & T, Smith K, Aslanidis J, Warde P, ) as confirmed by a recent multi‐institutional prospective trial (Gomez‐Iturriaga et al, ). The cumulative incidence of pain flare ranged between 23%–68% (Chiang et al, ; Pan et al, ) when patients were treated for a spinal metastases and was 10% for extraspinal sites (Owen et al, ).…”

“…Pain flare was a frequent side effect of SBRT and was found in more than one third of patients in our series. TA B L E 2 Pain complexity according to ECS-CP (per patient and per treatment site) and correlation with steroid use, opioid medication and pain progression in patients with active pain at baseline (Gomez-Iturriaga et al, 2015). The cumulative incidence of pain flare ranged between 23%-68% (Chiang et al, 2013;Pan et al, 2014) when patients were treated for a spinal metastases and was 10% for extraspinal sites (Owen et al, 2014).…”

Analysis of predictors of pain response in patients with bone metastasis undergoing palliative radiotherapy: Does age matter?

“…19 From that cohort, a total of 128 patients returned the questionnaires 4 weeks after RT and were therefore eligible for assessment of pain response and corresponding analysis of clinical factors influencing this response. 19 From that cohort, a total of 128 patients returned the questionnaires 4 weeks after RT and were therefore eligible for assessment of pain response and corresponding analysis of clinical factors influencing this response.…”

“…In patients who met all the inclusion and none of the exclusion criteria, pain associated with the bone lesion was assessed using a numeric scale from 0 to 10. This study is a secondary analysis of the population initially recruited for the 'flare study' 19 for which the main endpoint was the incidence of the flare effect in patients undergoing bone palliative radiotherapy, analysed prospectively. In patients who met all the inclusion and none of the exclusion criteria, pain associated with the bone lesion was assessed using a numeric scale from 0 to 10. This study is a secondary analysis of the population initially recruited for the 'flare study' 19 for which the main endpoint was the incidence of the flare effect in patients undergoing bone palliative radiotherapy, analysed prospectively.…”

“…This study is a secondary analysis of the population initially recruited for the 'flare study' 19 for which the main endpoint was the incidence of the flare effect in patients undergoing bone palliative radiotherapy, analysed prospectively. The collected data of 204 patients including breast, prostate and lung cancer within the 'flare study' database were used.…”