scholarly journals Better pain control with 8-gray single fraction palliative radiotherapy for skeletal metastases: a Bayesian network meta-analysis

2021 ◽  
Author(s):  
Filippo Migliorini ◽  
Jörg Eschweiler ◽  
Andromahi Trivellas ◽  
Arne Driessen ◽  
Matthias Knobe ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Bayesian Network ◽  
Pain Control ◽  
Meta Analysis ◽  
Cord Compression ◽  
The Other ◽  
Skeletal Metastases ◽  
Pain Response ◽  
Pathological Fractures ◽  
Single Fraction

AbstractExternal Beam Radiotherapy (EBRT) allows remarkable pain control in patients with skeletal metastases. We performed a Bayesian network meta-analysis comparing the most commonly used radiotherapy regimens for palliative management in patients with skeletal metastases. The main online databases were accessed in October 2020. All randomized clinical trials evaluating the irradiation of painful bone metastases were considered. The following irradiation patterns were analysed and included in the present network meta-analysis: 8 Gy- and 10 Gy/single fraction, 20 Gy/5 fractions, 30 Gy/10 fractions. The Bayesian hierarchical random-effect model analysis was adopted in all comparisons. The Log Odds-Ratio (LOR) statistical method for dichotomic data was adopted for analysis. Data from 3595 patients were analysed. The mean follow-up was 9.5 (1 to 28) months. The cumulative mean age was 63.3 ± 2.9. 40.61% (1461 of 3595 patients) were female. The 8Gy/single fraction protocol detected reduced rate of “no pain response” (LOR 3.39), greater rate of “pain response” (LOR-5.88) and complete pain remission (LOR-7.05) compared to the other dose patterns. The 8Gy group detected a lower rate of pathological fractures (LOR 1.16), spinal cord compression (LOR 1.31) and re-irradiation (LOR 2.97) compared to the other dose patterns. Palliative 8Gy/single fraction radiotherapy for skeletal metastases shows outstanding results in terms of pain control, re-irradiations, pathological fractures and spinal cord compression, with no differences in terms of survivorship compared to the other multiple dose patterns.Level of evidence: I, Bayesian network meta-analysis of RCTs.

scholarly journals The Role of Axonal Transport in Neurodegenerative Disease Spread: A Meta-Analysis of Experimental and Clinical Poliomyelitis Compares with Amyotrophic Lateral Sclerosis

1991 ◽  
Vol 18 (S3) ◽  
pp. 435-438 ◽  
Author(s):  
Benjamin Rix Brooks
Keyword(s):  
Spinal Cord ◽  
Axonal Transport ◽  
Neuronal Degeneration ◽  
Meta Analysis ◽  
Gender Effects ◽  
The Other ◽  
Disease Spread ◽  
Local Spread ◽  
Other Hand ◽  
Bulbar Onset

ABSTRACT:ALS symptom spread results from local spread of the neuronal degeneration because contiguous areas are more quickly involved than non-contiguous areas. Local spread to contiguous areas of motor neuron dysfunction is faster at the brainstem, cervical and lumbar regions than spread to non-continguous areas. The time for caudal-rostral symptomatic spread of ALS to involve a distant region is a function of the distance of that region from the site of onset. The time for spread to the bulbar region is shorter following arm onset than leg onset. Spread to non-contiguous areas is faster within the spinal cord than from the spinal cord to the bulbar region. These kinetics are consistent with axonal transport of the etiological agent in a manner similar to spread of poliovirus in poliomyelitis patients. Spread from the bulbar region to the spinal cord, on the other hand, occurs faster than symptom spread from the limb region to the bulbar region in limb onset patients. This rapid limb involvement following bulbar onset is more dramatic in males compared with females. Females with leg onset, on the other hand, show more rapid involvement of the opposite leg, either arm or bulbar structures than males. Gender effects may determine the course of ALS depending on the original site of onset.

The use of Bisphosphonates in Patients with Breast Cancer

2002 ◽  
Vol 9 (6) ◽  
pp. 480-489 ◽  
Author(s):  
Catherine H. Van Poznak
Keyword(s):  
Breast Cancer ◽  
Spinal Cord ◽  
Randomized Clinical Trials ◽  
Bone Destruction ◽  
Metastatic Breast ◽  
Cord Compression ◽  
Bisphosphonate Therapy ◽  
Skeletal Metastases ◽  
Cancer Management ◽  
Pathologic Fractures

Background Bone is the most common site of breast cancer metastases. Skeletal metastases may be associated with harmful and painful events such as fractures, spinal cord compression, and hypercalcemia. By inhibiting osteoclasts and bone resorption, bisphosphonates can interrupt the process of bone destruction and decrease the risk of skeletal complications. Methods A review of the literature was undertaken regarding the use of bisphosphonates in breast cancer management, with particular attention to prospective, randomized clinical trials that have influenced the treatment of bone metastases. Results Large prospective, randomized trials have demonstrated that bisphosphonates are effective in reducing skeletal-related complications from metastatic breast cancer. Conclusions For many patients with osseous lesions from breast cancer, bisphosphonate therapy is a useful intervention in managing their disease. Bisphosphonates are the treatment of choice for hypercalcemia of malignancy and bisphosphonates reduce the risk of pathologic fractures, spinal cord compromise, the need for radiation or surgery to bone, and bone pain.

Effectiveness and toxicity of single-fraction radiotherapy with 1×8Gy for metastatic spinal cord compression

2005 ◽  
Vol 75 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Dirk Rades ◽  
Lukas J.A. Stalpers ◽  
Maarten C.C.M. Hulshof ◽  
Oliver Zschenker ◽  
Winfried Alberti ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Single Fraction

Direct hospital costs of skeletal-related events (SRE) in Portuguese patients (pts) with breast cancer (BC) and bone metastases

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17084-17084 ◽  
Author(s):  
J. Felix ◽  
V. Andreozzi ◽  
M. Soares ◽  
H. Gervásio ◽  
A. Moreira ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Zoledronic Acid ◽  
Bone Metastases ◽  
Treatment Cost ◽  
Hospital Costs ◽  
Cord Compression ◽  
Health Resource ◽  
Health Resource Utilization ◽  
Pathological Fractures

17084 Background: SRE such as pathological fractures, spinal cord compression, surgery or radiation therapy to bone and tumour- induced hypercalcemia account for substantial health resource utilization (HRU). The objective of this study was to investigate SRE-related direct hospital costs in Portuguese pts with BC and bone metastases. Methods: Pts with BC and at least one SRE within 12 months prior to study entry were eligible for this retrospective medical record review cost analysis study. SRE treatment cost were calculated by multiplying 12 month health resource utilization frequency (hospitalization, clinic visits, diagnostic tests, drugs) by the corresponding unit costs from the Portuguese Ministry of Health costs database. To account for the skewed nature of the data, costs were modelled using generalized linear models with gamma distribution and log link. Results: A total of 121 pts (age at bone metastases, mean 56.8 years, range 21- 89) from six different hospitals in Portugal were included. Median time from BC diagnosis to bone metastases was 38 months [CI95%: 24–57]. ECOG performance status at the time of SRE was 0 in 24.6% of pts, 1 in 45.9%, 2 in 18.0%, 3 in 8.2% and 4 in 3.3%. Total number of SRE over twelve months was 142 (mean 1.2 SRE/pts, SD=0.4) distributed as follows: pathological fractures (12.7%), spinal cord compression (4.9%), surgery to bone (1.4%), radiation therapy to bone (74.7%) and tumour induced hypercalcemia (6.3%) . Mean SRE treatment cost over 12 months was 5,963€ (SD=3,646€): hospitalization 1,312€, clinic visits 36€, diagnostics 103€, radiotherapy 1,481€, drugs 3,031€. According to biphosphonate (Bph) use in the prior 12 months, the mean (SD; pts) unadjusted SRE treatment cost was: no Bph 2,282€ (1,491; n=4), oral Bph 1,579€ (1,123; n=5), zoledronic acid 6,221€ (2,923; n=77), pamidronate 6,766€ (4,476; n=33). When excluding Bph costs, pamidronate pts were 1.8 [95% CI: 1.3–2.7] times more expensive than zoledronic acid when controlling for pts’ clinical characteristics. Conclusions: This study confirms prior data on the high cost of SRE in pts with BC metastatic to bone [Table: see text]

Single versus multifraction radiotherapy for spinal cord compression: A systematic review and meta-analysis

2019 ◽  
Vol 134 ◽  
pp. 55-66 ◽  
Author(s):  
Elysia K Donovan ◽  
Julianna Sienna ◽  
Gunita Mitera ◽  
Nidhi Kumar-Tyagi ◽  
Sameer Parpia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Meta Analysis ◽  
Cord Compression ◽  
Single Versus
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