Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy

Sze, W.M.; Shelley, Mike; Held, I. W.; Mason, Malcolm David

doi:10.1002/14651858.cd004721

Cited by 110 publications

(65 citation statements)

References 58 publications

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“…52,54 However, all studies reported that more retreatments were given after single-fraction radiotherapy. 53 This higher retreatment regimen seems to reflect more the uncertainty of both radiation oncologist and patient on the effect of such a "simple" treatment than its true ineffectiveness since patients who were treated by a single fraction were retreated with lower pain scores. 40,57 An ongoing prospectively randomized trial is currently studying the effectiveness of retreatment after single-and multiplefraction radiotherapy using different treatment schedules.…”

Section: External Beam Radiotherapy: Painmentioning

confidence: 99%

“…A single dose of 8 Gy has gained widespread acceptance, with response rates for pain of 60%. [52][53][54] For painful spinal metastases specifically, response percentages of 73% were reported in 342 patients who were treated within a randomized trial comparing single fraction of 8 Gy versus 24 Gy in 6 fractions. 47 If the diagnostic radiological investigations show extensive bone destruction, more irradiation (Ͼ25 Gy) is usually applied to induce remineralization and, hence, strengthening of the involved bone.…”

Section: External Beam Radiotherapy: Painmentioning

confidence: 99%

See 1 more Smart Citation

Spinal Extradural Metastasis: Review of Current Treatment Options

Bartels

Linden

Graaf

2008

CA: A Cancer Journal for Clinicians

198

145

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Bone metastases, especially to the spine, are frequently encountered during the course of a malignancy. Due to a worldwide increase of cancer incidence and to a longer life expectancy of patients with cancer, a rise in incidence of bone metastases is observed. A brief historical overview is the base of a review of current treatment options. Despite new developments in the surgical and radiotherapeutic fields, as well as in medical oncology, external beam radiotherapy is the cornerstone of the treatment of spinal metastases. In selected cases, surgical treatment is a proven option. Vertebroplasty or kyphoplasty can also be considered.Supportive medical care does not differ from that given for symptomatic lesions to the skeletal system elsewhere in the body. After discussing the treatment options, an algorithm is given. (CA Cancer J Clin 2008;58:245-259.)

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Section: External Beam Radiotherapy: Painmentioning

confidence: 99%

Section: External Beam Radiotherapy: Painmentioning

confidence: 99%

Spinal Extradural Metastasis: Review of Current Treatment Options

Bartels

Linden

Graaf

2008

CA: A Cancer Journal for Clinicians

198

145

View full text Add to dashboard Cite

show abstract

“…During recent years, more attention has been directed towards improved palliative care for cancer patients with skeletal metastases. Radiotherapy remains the mainstay for painful skeletal metastases (Sze et al 2003), but hormone therapy, chemotherapy, and biphosphonates (Diel et al 2004, Pavlakis et al 2005 are also important treatment modalities. The aim of surgical treatment is to restore function while alleviating pain.…”

Section: The Scandinavian Sarcoma Group Skeletal Metastasis Registrymentioning

confidence: 99%

The Scandinavian Sarcoma Group

Hall¹,

Eriksson

Bruland³

et al. 2009

Acta Orthopaedica

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“…Following low-dose conventional external beam palliative radiotherapy (cEBRT), 1 several randomized trials and meta-analyses have confirmed complete and overall pain response rates ranging from ∼10% to 30% and 50% to 70%, respectively. 2 …”

mentioning

confidence: 99%

Stereotactic Body Radiotherapy for Spinal Metastases

Chang

Shin

Yamada

et al. 2016

Spine

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Study Design Systematic literature review. Objectives To summarize the risks of 3 key complications of stereotactic body radiotherapy (SBRT) for spinal metastases, that is, radiation myelopathy (RM), vertebral compression fracture (VCF), and epidural disease progression, and to discuss strategies for minimizing them. Summary of Background Data RM, VCF and epidural disease progression are now recognized as important risks following SBRT for spine metastases. It is unclear at this stage exactly how large these risks are and what strategies can be employed to minimize these risks. Methods A systematic review of the literature using MEDLINE and a review of the bibliographies of reviewed articles on SBRT for spinal metastases were conducted. Results The initial literature search revealed a total of 376 articles, of which 38 were pertinent to the study objectives. The risk of RM following SBRT was found to be dependent on the maximum dose to the spinal cord and estimated to be <5% if the recommended published thecal sac dose constraints are adhered to. The crude risk of VCF was 13.7% (range: 0.7%- 40.5%), and, on average, 45% were surgically salvaged. It has been shown that the risk of VCF is dependent on several anatomic and tumor-related factors including the SBRT dose per fraction. The crude risk of local failure at 1 year was 21.4% (range: 12%–27%) of which 67% (range: 38%–96%) occurred within the epidural space. The grade of epidural disease has been shown to be associated with the risk of local failure. Conclusion The risk of RM after spinal SBRT is low in particular if recommended dose metrics are adhered to. There is a significant risk of both VCF and epidural disease progression after spinal SBRT. These risks can potentially be minimized by identifying the risk factors for these complications, and performing careful radiotherapy and surgical planning.

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Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy

Cited by 110 publications

References 58 publications

Spinal Extradural Metastasis: Review of Current Treatment Options

Spinal Extradural Metastasis: Review of Current Treatment Options

The Scandinavian Sarcoma Group

Stereotactic Body Radiotherapy for Spinal Metastases

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