Comparison of Various Radiotherapy Dose Fractionation Schedules in Palliation of Bone Metastasis

Abstract Introduction Bone metastasis is a common manifestation of malignancy. Bone metastases causes various morbidities and affect the quality of life. External beam radiotherapy is the mainstay of treatment of uncomplicated painful bone metastases. Different radiotherapy fractionation schedules are in practice for palliation of painful bone metastases. Objectives This study was aimed to compare and report the outcomes of various fractionation schedules of radiation therapy (RT) in terms of pain relief and quality of life in patients with painful bone metastases. Materials and Methods Eighty patients were randomized into four treatment arms with different RT fractionation schedules, namely, 8 Gy in 1 fraction, 20 Gy in 5 fractions, 24 Gy in 6 fractions, and 30 Gy in 10 fractions. Patients were assessed for pain by visual analog scale (VAS), performance status and quality of life before initiating the treatment, on the day of completion of treatment, and 1 week, 1 month, and 3 months of treatment completion. Results Majority of the metastases constituted from breast followed by lung cancer. Of these, 27.5% had metastases to the thoracic vertebra, 26.25% to the lumbar vertebra, 22.5% to the pelvis, 8.75% to the sternum, 6.25% each to cervical vertebra and femur, and 1.25% each to humerus and ribs. The mean VAS score prior to start of RT was 5.31, 5.21, 5.54, and 4.87 in arms A, B, C, and D, respectively. At the end of treatment, the scores were 3.0, 3.29, 2.77, and 2.47, respectively. At the end of 3 months, the scores were 1.54, 0.57, 0.54, and 0.60, respectively. The pain reduction was significant in all the four arms (p < 0.05). Also, 25% of the patients’ arm A had complete pain relief, whereas 45% of patients in arms B, C, and D had complete pain relief. In arm A, the performance status failed to improve at 3 months when compared with 1-week post-RT but the improvement was significant in the remaining three arms. There was improvement in the quality of life in all the arms, both in terms of function and symptoms. The mean score of symptomatic quality of life based on the EORTC BM22 module prior to start of RT was 38.14, 34.91, 28.85, and 29.17 in arms A, B, C, and D, respectively. There was a significant drop to 9.29, 6.55, 5.13, and 6.11 at 1-month posttreatment in the four arms, respectively. The outcomes in terms of functional quality of life showed a similar trend. Conclusion This study demonstrated that pain reduction by various RT fractionation schedules were similar, and no statistically significant difference was noted. Performance status and quality of life improved in all the four treatment arms post-RT.

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Radiotherapy plus either transdermal fentanyl or paracetamol and codeine for painful bone metastases: a randomised study of pain relief and quality of life

Current Medical Research and Opinion ◽

10.1185/030079903125002829 ◽

2004 ◽

Vol 20 (2) ◽

pp. 159-163 ◽

Cited By ~ 11

Author(s):

Kyriaki Pistevou-Gompaki ◽

Vassilis E. Kouloulias ◽

Charalambos Varveris ◽

Kyriaki Mystakidou ◽

Grigoris Georgakopoulos ◽

...

Keyword(s):

Quality Of Life ◽

Pain Relief ◽

Bone Metastases ◽

Transdermal Fentanyl ◽

Randomised Study ◽

Painful Bone Metastases

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1277 POSTER Quality of life in patients with painful bone metastases: results from the randomized dutch bone metastasis study on single fraction versus multiple fraction radiotherapy

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(05)81570-8 ◽

2005 ◽

Vol 3 (2) ◽

pp. 368 ◽

Cited By ~ 1

Keyword(s):

Quality Of Life ◽

Bone Metastasis ◽

Bone Metastases ◽

Single Fraction ◽

Fraction Versus ◽

Painful Bone Metastases

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Pain relief and quality of life following radiotherapy for bone metastases: a randomised trial of two fractionation schedules

Radiotherapy and Oncology ◽

10.1016/s0167-8140(97)00101-1 ◽

1997 ◽

Vol 45 (2) ◽

pp. 109-116 ◽

Cited By ~ 208

Author(s):

Mark N. Gaze ◽

Charles G. Kelly ◽

Gillian R. Kerr ◽

Ann Cull ◽

Valerie J. Cowie ◽

...

Keyword(s):

Quality Of Life ◽

Pain Relief ◽

Bone Metastases ◽

Randomised Trial ◽

Fractionation Schedules

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Course of Quality of Life After Radiation Therapy for Painful Bone Metastases: A Detailed Analysis From the Dutch Bone Metastasis Study

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2016.03.032 ◽

2016 ◽

Vol 95 (5) ◽

pp. 1391-1398 ◽

Cited By ~ 12

Author(s):

Paulien G. Westhoff ◽

Mathilde G.E. Verdam ◽

Frans J. Oort ◽

Jan J. Jobsen ◽

Marco van Vulpen ◽

...

Keyword(s):

Quality Of Life ◽

Radiation Therapy ◽

Bone Metastasis ◽

Bone Metastases ◽

Detailed Analysis ◽

Painful Bone Metastases

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Radiofrequency ablation for palliative treatment of osseous metastases results in rapid, significant, and durable improvements in pain relief and quality of life: Results from the OPuS One trial.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12086 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12086-12086

Author(s):

Jason Levy ◽

Elizabeth David ◽

Thomas Hopkins ◽

Jonathan Morris ◽

Nam D. Tran ◽

...

Keyword(s):

Quality Of Life ◽

Radiofrequency Ablation ◽

Pain Relief ◽

Bone Metastases ◽

Pain Score ◽

Palliative Treatment ◽

Vertebral Augmentation ◽

Painful Bone Metastases ◽

Treated Site

12086 Background: Patients with bone metastases may experience pain and decreased quality of life. Standard of care therapies such as radiation therapy could take weeks for pain relief and carry a risk of radiation induced fracture. Minimally invasive percutaneous radiofrequency ablation (RFA) have been shown in small observational studies to be an alternative treatment for bone metastases. We report the results of the OPuS One trial evaluating RFA for the palliative treatment of patients with painful bone metastases. Methods: OPuS One (NCT03249584) was a multicenter prospective trial. 218 subjects with painful bone metastases (≥ 4/10 worst pain scores, Brief Pain Inventory [BPI], at target treated site) were enrolled from 15 sites. RFA was performed under image guidance at one or two locations. Vertebral augmentation was followed based on physician’s discretion. Subjects’ pain (BPI) and quality of life (EQ-5D) scores were calculated in subjects at three days, one week, and one, three, six, and 12 months post RFA. Rate of complete (0 pain score at treated site with no concomitant analgesic increase) and partial responders (≥ 2 pain score reduction without analgesic increase or analgesic reduction of ≥ 25% from baseline) were calculated. Device-, procedure-, and/or therapy-related adverse events (AEs) were collected. Results: 206 subjects, 113 (55%) female and 93 (45%) males (mean age was 63.7 years) were treated with RFA. Most common primary cancers were breast (23%), lung (23%), and kidney (10%). 184 (89%) subjects were treated for metastatic lesions involving the thoracolumbar spine and 22 (11%) subjects were treated for iliac crest, periacetabulum, sacrum or mixed vertebral and pelvic location. 99% (262/264) of RFA procedures were technically successful and 97% were followed by vertebral augmentation. Subjects reported significant improvement in worst pain from baseline at 7.8 to 5.5, 4.7, 3.6, 3.2, 2.4, and 2.6 at three days, one week and one, three, six, and 12 months post RFA, respectively (p < 0.0001 for all visits). Significant improvements were also seen in average pain (p < 0.0001 for all visits), pain interference (p < 0.0001 for all visits), and quality of life scores (p < 0.0001 for all visits). Overall response rates were 53%, 58%, 61%, 63%, 70%, and 75% at three days, one week, one month, three months, six months, and twelve months post RFA, respectively. Six AEs were reported with three as serious: intra-abdominal fluid collection, pneumonia and respiratory failure. 82 deaths were reported during the study, none were related to the device, therapy, and/or procedure. No skeletal related events were reported. Conclusions: In a large prospective multicenter trial, OPuS One, RFA provided rapid, significant, and durable improvements in pain relief and quality of life up to 12 months. Clinical trial information: NCT03249584.

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Prospective cohort study of surgical outcome for spinal metastases in patients aged 70 years or older

The Bone & Joint Journal ◽

10.1302/0301-620x.102b12.bjj-2020-0566.r1 ◽

2020 ◽

Vol 102-B (12) ◽

pp. 1709-1716

Author(s):

Yutaro Kanda ◽

Kenichiro Kakutani ◽

Yoshitada Sakai ◽

Takashi Yurube ◽

Shingo Miyazaki ◽

...

Keyword(s):

Quality Of Life ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Spinal Metastases ◽

Palliative Surgery ◽

Advanced Age ◽

Health State ◽

Survival Times ◽

The Mean

Aims With recent progress in cancer treatment, the number of advanced-age patients with spinal metastases has been increasing. It is important to clarify the influence of advanced age on outcomes following surgery for spinal metastases, especially with a focus on subjective health state values. Methods We prospectively analyzed 101 patients with spinal metastases who underwent palliative surgery from 2013 to 2016. These patients were divided into two groups based on age (< 70 years and ≥ 70 years). The Eastern Cooperative Oncology Group (ECOG) performance status (PS), Barthel index (BI), and EuroQol-5 dimension (EQ-5D) score were assessed at study enrolment and at one, three, and six months after surgery. The survival times and complications were also collected. Results In total, 65 patients were aged < 70 years (mean 59.6 years; 32 to 69) and 36 patients were aged ≥ 70 years (mean 75.9 years; 70 to 90). In both groups, the PS improved from PS3 to PS1 by spine surgery, the mean BI improved from < 60 to > 80 points, and the mean EQ-5D score improved from 0.0 to > 0.7 points. However, no significant differences were found in the improvement rates and values of the PS, BI, and EQ-5D score at any time points between the two groups. The PS, BI, and EQ-5D score improved throughout the follow-up period in approximately 90% of patients in each group. However, the improved PS, BI, and EQ-5D scores subsequently deteriorated in some patients, and the redeterioration rate of the EQ-5D was significantly higher in patients aged ≥ 70 than < 70 years (p = 0.027). Conclusion Palliative surgery for spinal metastases improved the PS, activities of daily living, and quality of life, regardless of age. However, clinicians should be aware of the higher risk of redeterioration of the quality of life in advanced-age patients. Cite this article: Bone Joint J 2020;102-B(12):1709–1716.

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Hypofractionated radiotherapy for complicated bone metastases in patients with poor performance status: a phase II international trial

Tumori Journal ◽

10.5301/tj.5000658 ◽

2018 ◽

Vol 105 (2) ◽

pp. 181-187 ◽

Cited By ~ 3

Author(s):

Mauricio F. Silva ◽

Gustavo N. Marta ◽

Felipe P.C. Lisboa ◽

Guilherme Watte ◽

Fabio Trippa ◽

...

Keyword(s):

Quality Of Life ◽

Bone Metastases ◽

Phase Ii ◽

Weight Bearing ◽

Performance Status ◽

Poor Performance ◽

Hypofractionated Radiotherapy ◽

Poor Performance Status ◽

Life Questionnaire

Purpose: To evaluate the efficacy and safety of hypofractionated radiotherapy (16 Gy in 2 fractions, 1 week apart) in patients with complicated bone metastases and poor performance status. Methods: A prospective single-arm phase II clinical trial was conducted from July 2014 to May 2016. The primary endpoint was pain response as defined in the International Consensus on Palliative Radiotherapy Endpoints. Secondary endpoints included quality of life as measured by quality of life questionnaire (QLQ) PAL-15 and QLQ-BM22 European Organisation for Research and Treatment of Cancer guidelines, pain flare, adverse events, re-irradiation, and skeletal complications. Results: Fifty patients were enrolled. There were 23 men with a median age of 58 years (range 26-86). Of the 50 patients, 38 had an extraosseous soft tissue component, 18 needed postsurgical radiation, 3 had neuropathic pain, and 3 had an impending fracture in a weight-bearing bone. At 2 months, 33 patients were alive (66%). Four (12.5%) had a complete response and 12 (37.5%) had a partial response. A statistically significant improvement was seen in the functional interference (p = 0.01) and psychosocial aspects (p = 0.03) of the BM22. No patient had spinal cord compression. One patient required surgery for pathologic fracture, and another re-irradiation. Conclusions: Hypofractionated radiotherapy (16 Gy in 2 fractions of 8 Gy 1 week apart) achieved satisfactory pain relief and safety results in patients with complicated bone metastases and poor performance status.

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