Quality of life improvement in patients with bone metastases undergoing palliative radiotherapy

Cañón, Verónica; Gómez-Iturriaga, A.; Casquero, F.; Rades, Dirk; Navarro, Arturo; Hoyo, O. del; Morillo, V.; Willisch, P.; López-Guerra, José Luis; Illescas-Vacas, A.; Ciérvide, R.; Martínez-Indart, Lorea; Cacicedo, Jon

doi:10.5603/rpor.a2022.0048

Cited by 4 publications

(3 citation statements)

References 35 publications

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“…One may also argue that limited PRL on treatment is not a surrogate of net appropriateness, efficacy or optimal balance. For example, if 3% PRL would result in short-lived and less complete symptom palliation, while 6% would result in a larger gain, patients could be willing to accept prolonged treatment, because the quality of their remaining life improves [ 12 ]. Such trade-off would also have to consider toxicity, inconvenience and cost related to transportation, treatment itself and other factors.…”

Section: Discussionmentioning

confidence: 99%

Percent of remaining life on palliative radiation treatment: solely a function of fractionation?

Nieder

Mannsåker

Dalhaug

2023

Rep Pract Oncol Radiother.

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Background This study analyzed the percent of remaining life (PRL) on treatment in patients irradiated for bone metastases. Bone metastases were treated together with other target volumes, if indicated, e.g. a 10-fraction treatment course that included brain and bone metastases. PRL was determined by calculating the time between start and finish of palliative radiotherapy (minimum 1 day in case of a single-fraction regimen) and dividing it by overall survival in days from start of radiotherapy. Materials and methods Different baseline parameters were assessed for association with dichotomized PRL (< 5% vs . ≥ 5%). The retrospective study included 219 patients (287 courses of palliative radiotherapy). After univariate analyses, multi-nominal logistic regression was employed. Results PRL on treatment ranged from 1–23%. Single-fraction radiotherapy resulted in < 5% PRL on treatment in all cases. All courses with 10 fractions resulted in at least 5% PRL on treatment. Significant associations were found between various baseline parameters and PRL category. With fractionation included in the regression model, 3 parameters retained significant p-values: Karnofsky performance status (KPS), none-bone target volume and fractionation (all with p < 0.001). If analyzed without fractionation, none-bone target volume (p < 0.001), hemoglobin (p < 0.001), KPS (p = 0.01), lack of additional systemic treatment (p = 0.01), and hypercalcemia (p = 0.04) were significant. Conclusions Fractionation is an easily modifiable factor with high impact on PRL. Patients with KPS < 70 and those treated for additional target types during the same course are at high risk of spending a larger proportion of their remaining life on treatment.

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Section: Discussionmentioning

confidence: 99%

Percent of remaining life on palliative radiation treatment: solely a function of fractionation?

Nieder

Mannsåker

Dalhaug

2023

Rep Pract Oncol Radiother.

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“…Since shortly following the discovery of X-rays in 1896, RT has been widely used as a noninvasive palliative treatment option for local symptom relief, including relief of pain and cessation of hemorrhage. [12][13][14][15] Being a treatment option with a limited treatment burden with regard to side-effects and the short treatment period, palliative RT has been shown to improve patient's QOL. 16 Surprisingly, there is a paucity of literature describing palliative RT for ulcerating/fungating breast lesions.…”

Section: Introductionmentioning

confidence: 99%

Palliative Radiotherapy for Symptomatic Locally Advanced Breast Cancer

Hoeltgen

Meixner

Hoegen

et al. 2023

Technol Cancer Res Treat

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Objective: Women with locally advanced breast cancer (LABC) or inoperable local recurrence often suffer from a significantly reduced quality of life (QOL) due to local tumor-associated pain, bleeding, exulceration, or malodorous discharge. We aimed to further investigate the benefit of radiotherapy (RT) for symptom relief while weighing the side-effects. Materials and methods: Patients who received symptom-oriented RT for palliative therapy of their LABC or local recurrence in the Department of Radiation Oncology at Heidelberg University Hospital between 2012 and 2021 were recorded. Clinical, pathological, and therapeutic data were collected and the oncological and symptomatic responses as well as therapy-associated toxicities were analyzed. Results: We retrospectively identified 26 consecutive women who received palliative RT with a median total dose of 39 Gy or single dose of 3 Gy in 13 fractions due to (impending) exulceration, pain, local hemorrhage, and/or vascular or plexus compression. With a median follow-up of 6.5 months after initiation of RT, overall survival at 6 and 12 months was 60.0% and 31.7%, and local control was 75.0% and 47.6%, respectively. Radiation had to be discontinued in 4 patients due to oncological clinical deterioration or death. When completed as initially planned, symptom improvement was achieved in 95% and WHO level reduction of analgesics in 28.6% of patients. In 36% (16%) of patients, local RT had already been indicated >3 months (>6 months) before the actual start of RT, but was delayed or not initiated among others in favor of drug alternatives or systemic therapies. RT-associated toxicities included only low-grade side-effects (CTCAE I°-II°) with predominantly skin erythema and fatigue even in the context of re-RT. Conclusion: Palliative RT in symptomatic LABC or locoregional recurrence is an effective treatment option for controlling local symptoms with only mild toxicity. It may thus improve QOL and should be considered early in palliative patient care management.

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“…ECOG -Eastern Cooperative Oncology Group; RT -radiotherapy pain is of paramount importance in these groups of patients to improve quality of life [10,23,24].…”

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confidence: 99%

Comparison of twice weekly palliative RT versus continuous hypofractionated palliative RT for painful bone metastases

Bandyopadhyay

Ghosh

Chhatui

et al. 2023

Rep Pract Oncol Radiother.

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Background: Palliative hypofractionated radiotherapy (RT) is an effective mode of treating painful bone metastasis. While 8 Gy single fraction radiation is often effective for the same, for complicated bone metastases a protracted fractionated regimen is preferred, of which 30 Gy/10#/2weeks or 20 Gy/5#/1 week are the most common worldwide. However such schedules add to the burden of already overburdened radiation treatment facilities in a busy center, wherein alternative logistic favourable schedules with treatment on weekends are preferred. Here we compare the efficacy of a twice weekly schedule to that of standard continuous 20 Gy/5 #/1 week schedule in terms of pain relief, response and quality of life. Materials and methods:A prospective non randomized study was undertaken from Jan 2018 to May 2019, wherein eligible patients of complicated bone metastases received palliative radiotherapy of 20 Gy/5#, either continuously for 5 fractions from Monday to Saturday or twice weekly, Saturday and Wednesday, starting on a Saturday over about 2 weeks. Pain relief was assessed by the Visual Analogue Scale (VAS) and FACES pain scale recorded prior to starting palliative RT and at 4 weeks, 3 months and 6 months.Results: Thirteen patients received continuous Hypofractionated RT while 16 received it in a twice weekly schedule. Spine was the most common site receiving palliative Radiation (27/29), while breast cancer was the most common primary (16/29). The demographic and the baseline characteristics were comparable. The mean pain score decline at 4 weeks was 2.56 ± 1.1 and 2.71 ± 0.52 in the 5-day and the two-week schedule, respectively (p = 0.67). Conclusion:A twice weekly schedule over about two weeks was found to be equivalent in pain control and response to the standard fractionated palliative radiation and, thus, can be safely employed in resource constrained, busy radiotherapy centers.

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Quality of life improvement in patients with bone metastases undergoing palliative radiotherapy

Abstract: This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited.

Cited by 4 publications

References 35 publications

Percent of remaining life on palliative radiation treatment: solely a function of fractionation?

Percent of remaining life on palliative radiation treatment: solely a function of fractionation?

Palliative Radiotherapy for Symptomatic Locally Advanced Breast Cancer

Comparison of twice weekly palliative RT versus continuous hypofractionated palliative RT for painful bone metastases

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