Single-dose half-body irradiation for palliation of multiple bone metastases from solid tumors: Final radiation therapy oncology group report

Abstract

This is the final analysis of Protocol #78-10 which explored increasing singledoses of half-body irradiation (HBI) in patients with multiple (symptomatic) osseous metastases. When given as palliation, HBI was found to relieve pain in 73% of the patients. In 20% of the patients the pain relief was complete; over two thirds of all patients achieved better than 50% pain relief. The HBI pain relief was dramatic with nearly 50% of all responding patients doing so within 48 hours and 80% within one week from HBI treatment. Furthermore, the pain relief was long-lasting and continued without need of retreatment for at least 50% of the remaining patient's life. These results compare favorably with those obtained by the Radiation Therapy Oncology Group (RTOG) using several conventional daily fractionated schemes on similar patients in a prior study (RTOG #74-02). HBI achieves pain relief sooner and with less evidence of pain recurrence in the irradiated area than conventionally treated patients. The most effective and safest of the HBI doses tested were 600 rad for the upper HBI and 800 rad for the lower or mid-HBI. Increasing doses beyond these levels did not increase pain relief, duration of relief, or achieved a faster response; however, the increase in dose was associated with a definite increase in toxicity. Single-dose HBI was well tolerated with no fatalities seen among 168 treated patients. A comprehensive premedication program has proven to decrease the acute radiation syndrome to very acceptable levels. There were excellent responses found in practically all tumors treated, but especially breast and prostate among which over 80% of all patients experienced pain relief, 30% in a complete fashion. Single-dose HBI emerges as one of the safest, fastest, and more effective palliative tools for intractable cancer pain in modem radiation oncology. Cancer 58:29-36, 1986.

Half body irradiation of patients with multiple bone metastases: A phase II trial

“…This is consistent with the findings in another prospective study by Salazar et al [11] where pain relief was reported in up to 73% of the patients receiving HBI. Salazar et al compared their findings with those of conventional localized RT [11,14] and reported that response rates were similar, but the pain relief with HBI was achieved sooner and with less evidence of recurrence of pain in the treated area compared to conventional RT.…”

“…A more serious side effect of upper HBI is pneumonitis. Most of the literature on HBI is retrospective [11,12].…”

The role of vertebroplasty in metastatic spinal disease

“…Both conventional fractionated and nonfractionated radiotherapy are associated with similar rates of pain control at 6 months. 14,26 Pain relief following radiotherapy, however, is often delayed 10 to 20 days, and only minimal vertebral strengthening occurs. Unlike the delayed effects of radiotherapy, vertebroplasty provides immediate strengthening of the anterior column, which may limit painful VB collapse.…”

Direct evidence of lipid translocation between adipocytes and prostate cancer cells with imaging FTIR microspectroscopy

“…The linkage between lipids and advanced CaP may also be reflected in the natural history of this disease, because it is well documented that circulating metastatic CaP cells in the peripheral blood possess a predilection for deposition into the bone marrow stroma (BMS) (8), which harbors a rich source of lipids stored within adipocytes. Brown et al (9) have shown that PC-3 cell (human CaP cell line derived from bone metastases) invasion toward BMS was significantly reduced when the experiment was repeated with BMS grown in the absence of hydrocortisone so that adipocyte formation was not stimulated.…”