Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases

Wu, Jackson; Wong, Rebecca; Johnston, Mary; Bezjak, Andrea; Whelan, Timothy J.

doi:10.1016/s0360-3016(02)04147-0

Cited by 519 publications

(318 citation statements)

References 28 publications

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“…S everal recent metaanalyses of randomized radiotherapy studies have investigated the role of differing fractionation schedules for palliation of painful bone metastases. 1,2 The quality of previous evidence in this area has been questioned, 3 and it is known that poorquality randomized studies may potentially invalidate the results and conclusions of individual studies and subsequent metaanalyses. 4 In particular, subjective end points such as retreatment rates (an important end point for many patients 5 ) may not be reliably ascertained due to potential biases that are a direct result of study design, a finding acknowledged by several authors.…”

Section: Resultsmentioning

confidence: 99%

“…Most authors reviewing the quality of studies investigating analgesic interventions (including studies evaluating radiotherapy) have used Jadad's instrument, which is the only validated tool currently available. 1,2,4,28,29 This instrument was specifically designed for use in assessing randomized studies in pain research, but is not without drawbacks. One limitation is that it has only been validated for English-language studies published in full form.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the quality of radiotherapy randomized trials for painful bone metastases

Shakespeare

Thiagarajan

Gebski

2005

Cancer

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BACKGROUNDThe quality of randomized radiotherapy studies investigating the palliation of painful bone metastases has been questioned, with some authors recognizing the potential impact of bias on result interpretation. However, there has been no published comprehensive evaluation of quality assessment. The goals of the current study were to evaluate the quality of randomized studies using a validated checklist and to discuss implications and future directions.METHODSThe authors performed a search for studies that could be reliably assessed using the validated quality assessment instrument. Independent assessors scored study quality using the instrument.RESULTSThe median quality score of the 17 identified randomized studies was 1 of 5 (range, 0–3). The majority (71%) of points were awarded for the authors describing the study as “randomized.” The method of randomization and description of withdrawals and dropouts were scored poorly for most studies. None of the studies were awarded points for allocation concealment (blinding). The overall quality was deemed poor (a score of 0–2) for 16 of 17 (94%) studies.CONCLUSIONSThe quality of published randomized evidence comparing efficacy of fractionation schedules for the palliation of bone metastases was suboptimal. As a result of the potential biases present, subjective end points (e.g., retreatment rates) cannot be reliably evaluated. Greater efforts are required by radiation oncology trial groups to improve quality, with a particular focus on developing methods of allocation concealment and comprehensively reporting results. Cancer 2005. © 2005 American Cancer Society.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of the quality of radiotherapy randomized trials for painful bone metastases

Shakespeare

Thiagarajan

Gebski

2005

Cancer

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“…During the past two decades, several clinical trials have compared the relative efficacy of various dose-fractionation schedules in producing pain relief. 17 The idea of single-fraction radiotherapy for symptomatic bone metastases is not new. Several studies, including a Radiation Therapy Oncology Group Phase III trial, as well as a meta-analysis, found no significant difference in complete and overall pain relief between single-fraction and multifraction palliative radiation therapy for bone metastases.…”

Section: Figurementioning

confidence: 99%

“…Several studies, including a Radiation Therapy Oncology Group Phase III trial, as well as a meta-analysis, found no significant difference in complete and overall pain relief between single-fraction and multifraction palliative radiation therapy for bone metastases. 16,17 Most of these trials used 8 Gy in a single fraction. However, none of these trials were specifically evaluating spinal metastases.…”

Section: Figurementioning

confidence: 99%

“…[12][13][14][15] Studies have previously determined the clinical efficacy of single-fraction therapy for painful bone metastases. 16,17 A primary factor that limits radiation dose for local vertebral tumor control with conventional radiotherapy is the relatively low tolerance of the spinal cord to radiation. Conventional external beam radiotherapy lacks the precision to deliver large singlefraction doses of radiation to the spine near radiosensitive structures such as the spinal cord.…”

mentioning

confidence: 99%

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Single‐fraction radiosurgery for the treatment of spinal breast metastases

Gerszten

Burton

Welch

et al. 2005

Cancer

126

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BACKGROUNDThe spine is the most common site of bony metastases in patients with osseous breast carcinoma metastases. Spine metastases are the source of significant pain and occasionally neurologic deficit in this patient population. Conventional external beam radiotherapy lacks the precision to allow delivery of large single‐fraction doses of radiation and simultaneously limit the dose to radiosensitive structures such as the spinal cord. This study evaluated the clinical efficacy of the treatment of spinal breast carcinoma metastases with a single‐fraction radiosurgical technique.METHODSIn this prospective cohort evaluation, 68 breast carcinoma metastases to the spine in 50 patients were treated with a single‐fraction radiosurgery technique with a follow‐up period of 6–48 months, median 16 months. The most common indication for radiosurgery treatment was pain in 57 lesions, as a primary treatment modality in 8 patients, and for radiographic tumor progression, as a postsurgical boost, and for a progressive neurologic deficit in 1 patient each.RESULTSTumor volume ranged from 0.8–197 cm3 (mean, 27.7 cm3). Maximum tumor dose was maintained at 15–22.5 Gy (mean, 19 Gy). No radiation‐induced toxicity occurred during the follow‐up period (6–48 mo). Long‐term axial and radicular pain improvement occurred in 55 of 57 (96%) patients who were treated primarily for pain. Long‐term radiographic tumor control was seen in all patients who underwent radiosurgery as their primary treatment modality, for radiographic tumor progression, or as a postsurgical treatment.CONCLUSIONSSpinal radiosurgery was found to be feasible, safe, and clinically effective for the treatment of spinal metastases from breast carcinoma. The results indicate the potential of radiosurgery in the treatment of patients with spinal breast metastases, especially those with solitary sites of spine involvement, to improve long‐term palliation. Cancer 2005. © 2005 American Cancer Society.

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