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

Loi, Mauro; Klass, Natalie Désirée; Vries, Kim C. de; Fleury, E.; Zwienen, M. van; Pree, Ilse de; Nuyttens, J.

doi:10.1111/ecc.12915

Cited by 9 publications

(6 citation statements)

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“…Cumulative incidence of pain flare ranging between 10 and 68%70,75,76 has been reported, with single‐fraction dose regimen76 and lack of steroid pretreatment77 being the main predictors. In our experience, pain flare occurred following 34% of SBRT treatments74 but no variable was associated with its onset.…”

Section: Extra-spinal Bone Metastasesmentioning

confidence: 70%

“…Most interestingly, a recent phase II trial73 comparing single-fraction SBRT to multifraction CRT, reported significantly higher rates of pain response both at early (2 weeks) and late (9 months) evaluation. Interestingly, according to a recent study from our group, no specific SBRT dose fractionation was correlated to pain control, that was mostly influenced by patient-related features identified with the use of validated tools such as the ECS‐CP 74. Concerning toxicity, severe adverse events correlated with bone irradiation included fracture and pain flare (defined as acute onset or exacerbation of pain in relation to radiotherapy) 75.…”

Section: Extra-spinal Bone Metastasesmentioning

confidence: 99%

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<p>Single-Fraction Radiotherapy (SFRT) For Bone Metastases: Patient Selection And Perspectives</p>

Loi

Nuyttens

Desideri

et al. 2019

CMAR

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Bone metastases are a frequent and important source of morbidity in cancer patients. Stereotactic body radiation therapy (SBRT) is an established treatment option for local control and pain relief of bone metastases, and it is increasingly used as upfront treatment, postoperative consolidation or salvage treatment after prior RT. However, heterogeneity of dose schedules described in literature represents a severe limitation in the definition of the role of SBRT as a standard of care. No consensus is available on the use of single versus multiple fraction SBRT for bone metastases. Advantages of single-fraction SBRT include shorter overall duration of treatment, absence of inter-fraction uncertainty, improved compliance, theoretical increased efficacy, and lower costs. However, caution has been advised due to reports of severe late toxicities, in particular, vertebral collapse fracture (VCF). The aim of this paper is to review dose fractionation and indications for the management of bone metastases using SBRT.

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Section: Extra-spinal Bone Metastasesmentioning

confidence: 70%

Section: Extra-spinal Bone Metastasesmentioning

confidence: 99%

<p>Single-Fraction Radiotherapy (SFRT) For Bone Metastases: Patient Selection And Perspectives</p>

Loi

Nuyttens

Desideri

et al. 2019

CMAR

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“…Only 1 relatively small single-arm retrospective study reported on pain response in oligometastatic patients according to international guidelines after SBRT. 27 It found a comparable 1-year pain control of 62% in 23 patients with a baseline NRS ! 2.…”

Section: [46%]mentioning

confidence: 95%

Patient-Reported Outcomes of Oligometastatic Patients After Conventional or Stereotactic Radiation Therapy to Bone Metastases: An Analysis of the PRESENT Cohort

Ven

Bongard

Pielkenrood

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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This study shows the paradigm shift toward radical treatment in oligometastastic disease. Survival outcomes of patients with oligometastates are improving, and therefore optimization of palliative care is needed. Clinical local control rates are higher after stereotactic body radiation therapy to bone metastastes compared with conventional radiation therapy, but stereotactic body radiation therapy does not improve pain response or quality of life in oligometastastic patients. Purpose: Stereotactic body radiation therapy (SBRT) has become a widely adopted treatment for patients with oligometastatic disease, despite limited evidence of superiority. We compared pain response and quality of life (QoL) in patients with oligometastatic disease treated with conventionally fractionated 3-dimensional radiation therapy (3DCRT) or SBRT to bone metastases. Methods and Materials: We included patients with oligometastatic disease (5 lesions within 3 organs) treated within the prospective PRESENT cohort. Main outcomes were pain response, clinical local control, and QoL 2, 4, and 8 weeks and 3, 6, and 12 months after treatment. Pain response was assessed only in patients who reported pain at baseline and was defined according to international consensus criteria. Results: Of 131 patients with oligometastatic disease, 66 patients were treated with 3DCRT and 65 patients with SBRT. A pain response was achieved in 81% (3DCRT) versus 84% (SBRT) with a median duration of 23 weeks (range, 1-58) and 24 weeks (range, 0-50), respectively. Reirradiation was needed in 33% versus 5% of the patients, respectively. None of the QoL subscales were significantly different between both groups. Conclusions: In patients with oligometastatic disease, SBRT to bone metastases did not improve pain response or QoL compared with 3DCRT. Reirradiation was less often needed in the SBRT group.

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“…клинические проявления, связанные с осложнениями костных метастазов, а также обеспечить локальный контроль костных метастатических очагов. [6,16].…”

Section: Introductionunclassified

Projection into the future: combination of orphenadrine and diclofenac in patients with bone metastases

et al. 2022

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Introduction. Radiation therapy is an effective method of treating pain in patients with bone metastases, but during radiotherapy there is often an increase in pain. The presence of a new drug containing a combination of orphenadrine and diclofenac in oncologists expands the possibilities of analgesia.Aim. To evaluate the efficacy and safety of the use of a fixed combination of diclofenac and orphenadrine in patients with pain due to metastatic bone damage during radiotherapy.Materials and methods. The patients were randomized into two groups: the first group (n = 30) received the drug Neodolpasse intravenously once a day for two days; the second - 2 times a day (n = 30) - 2 days. Efficacy was evaluated based on the following measurements: intensity of pain by NRS immediately after administration of the drug, after 30 minutes, after 1, 2, 4 and 24 hours, the dynamics of daily doses of analgesics.Results and discussion. In group 1, a meaningful decrease in pain intensity (p < 0.05) from 48.7 ± 10.6 mm to 26.8 ± 10.7 mm was achieved 30 minutes after the completion of infusion. The pain intensity measured by the Numeric Rating Scale (NRS) reached its minimum value 2 hours after the completion of infusion (22.5 ± 12.0 mm). In group 2, the pain intensity decreased 30 minutes after the completion of infusion, a meaningful decrease (p < 0.05) in pain intensity was achieved from 56.5 ± 9.8 mm to 34.0 ± 10.5 mm, and up to 29.8 ± 10.2 mm after the second dose. The pain intensity decreased by 45.9% in group 1 and by 47.9% in group 2 towards the end of the Neodolpasse therapy cycle. During the study, two mild to moderate adverse events (nausea, drop in blood pressure) that did not require any significant drug therapy were observed.Conclusion. The results of the study confirm that the use of the drug according to the proposed method is a safe and effective way of treating pain syndrome during radiotherapy in patients with metastatic bone damage.

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

Cited by 9 publications

References 24 publications

<p>Single-Fraction Radiotherapy (SFRT) For Bone Metastases: Patient Selection And Perspectives</p>

<p>Single-Fraction Radiotherapy (SFRT) For Bone Metastases: Patient Selection And Perspectives</p>

Patient-Reported Outcomes of Oligometastatic Patients After Conventional or Stereotactic Radiation Therapy to Bone Metastases: An Analysis of the PRESENT Cohort

Projection into the future: combination of orphenadrine and diclofenac in patients with bone metastases

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