Personalized Radiation Therapy in Cancer Pain Management

Abstract

The majority of advanced cancer patients suffer from pain, which severely deteriorates their quality of life. Apart from analgesics, bisphosphonates, and invasive methods of analgesic treatment (e.g., intraspinal and epidural analgesics or neurolytic blockades), radiation therapy plays an important role in pain alleviation. It is delivered to a growing primary tumour, lymph nodes, or distant metastatic sites, producing pain of various intensity. Currently, different regiments of radiation therapy methods and techniques and various radiation dose fractionations are incorporated into the clinical practice. These include palliative radiation therapy, conventional external beam radiation therapy, as well as modern techniques of intensity modulated radiation therapy, volumetrically modulated arch therapy, stereotactic radiosurgery or stereotactic body radiation therapy, and brachytherapy or radionuclide treatment (e.g., radium-223, strontium-89 for multiple painful osseous metastases). The review describes the possibilities and effectiveness of individual patient-tailored conventional and innovative radiation therapy approaches aiming at pain relief in cancer patients.

Skeletal Metastases of Unknown Primary: Biological Landscape and Clinical Overview

“…Bone-seeking radiopharmaceuticals have been employed as active osteotropic approaches [83], representing calcium mimetics in the bone compartement, which emit alpha, beta, and gamma particles. Strontium-89 chloride, Samarium-153-ethylenediamine tetramethylene phosphonic acid (EDTMP), Rhenium-186-hydroxyethylidine diphosphonic acid (HEDP), and Radium-233 dichloride were indicated for the treatment of painful lesions due to osteoblastic or mixed bone metastases, mainly from breast and prostate tumors and other cancers with osteoblastic skeletal spreading, detected by whole-body bone scans performed ahead of treatment [83]. These compounds mainly target osteoblastic skeletal lesions, however, they are not effective on lytic bone lesions, increasing the fracture incidence [84].…”

Biological and Clinical Aspects of Metastatic Spinal Tumors

“…Tumor cells then release cytokines that aim to further stimulate osteoclasts and, in consequence, bone resorption. Novel literature delivers evidence that radiation treatment not only acts on OCs and OBs, but also changes the bone microenvironment, including by reduction of inflammatory cells and chemical pain mediators which, in turn, results in cancer-induced pain relief [ 262 , 263 , 264 ] ( Figure 4 ).…”

Modern diagnostics and treatment of distant metastasis of cervical cancer

“…Если целью лечения является облегчение боли, то в качестве стандартного фракционирования дозы для симптоматических и неосложненных метастазов в кости рекомендуется однократная доза в 8 Гр, назначенная до соответствующего целевого объема. Однако общая доза 30 Гр за 10 фракций также считается стандартным методом с более низкой частотой патологических переломов и компрессии спинного мозга [37]. Относительно химиотерапии, за исключением внутривенного введения, паллиативная транскатетерная артериальная химиоэмболизация/эмболизация может быть подходящим методом симптоматического лечения метастазов в кости, поскольку он является минимально инвазивным, повторяемым, эффективным и быстродействующим [38].…”