Better Pain Control with 8-gray Single Fraction Palliative Radiotherapy for Skeletal Metastases: a Bayesian Network Meta-analysis

Overview

Journal Clin Exp Metastasis

Specialty Oncology

Date 2021 Feb 9

PMID 33559808

Citations 3

Authors

Filippo Migliorini

Jorg Eschweiler

Andromahi Trivellas

Arne Driessen

Matthias Knobe

Markus Tingart

Nicola Maffulli

Affiliations

Soon will be listed here.

Abstract

External 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.

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References

Fairchild A, Barnes E, Ghosh S, Ben-Josef E, Roos D, Hartsell W . International patterns of practice in palliative radiotherapy for painful bone metastases: evidence-based practice?. Int J Radiat Oncol Biol Phys. 2009; 75(5):1501-10. DOI: 10.1016/j.ijrobp.2008.12.084. View

Koswig S, Budach V . [Remineralization and pain relief in bone metastases after after different radiotherapy fractions (10 times 3 Gy vs. 1 time 8 Gy). A prospective study]. Strahlenther Onkol. 1999; 175(10):500-8. DOI: 10.1007/s000660050061. View

Lutz S, Berk L, Chang E, Chow E, Hahn C, Hoskin P . Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys. 2011; 79(4):965-76. DOI: 10.1016/j.ijrobp.2010.11.026. View

Migliorini F, Maffulli N, Trivellas A, Eschweiler J, Tingart M, Driessen A . Bone metastases: a comprehensive review of the literature. Mol Biol Rep. 2020; 47(8):6337-6345. DOI: 10.1007/s11033-020-05684-0. View

Hutton B, Salanti G, Caldwell D, Chaimani A, Schmid C, Cameron C . The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015; 162(11):777-84. DOI: 10.7326/M14-2385. View

Goldman L, Caldera D, Nussbaum S, Southwick F, Krogstad D, Murray B . Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977; 297(16):845-50. DOI: 10.1056/NEJM197710202971601. View

Bayard L, Buzon M, Angulo Pain E, de Ingunza Baron L . Radiation therapy for the management of painful bone metastases: Results from a randomized trial. Rep Pract Oncol Radiother. 2014; 19(6):405-11. PMC: 4201774. DOI: 10.1016/j.rpor.2014.04.009. View

Coleman R . Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev. 2001; 27(3):165-76. DOI: 10.1053/ctrv.2000.0210. View

Guise T, Mundy G . Cancer and bone. Endocr Rev. 1998; 19(1):18-54. DOI: 10.1210/edrv.19.1.0323. View

10.

Powles T, Paterson S, Kanis J, McCloskey E, Ashley S, Tidy A . Randomized, placebo-controlled trial of clodronate in patients with primary operable breast cancer. J Clin Oncol. 2002; 20(15):3219-24. DOI: 10.1200/JCO.2002.11.080. View

11.

Li S, Peng Y, Weinhandl E, Blaes A, Cetin K, Chia V . Estimated number of prevalent cases of metastatic bone disease in the US adult population. Clin Epidemiol. 2012; 4:87-93. PMC: 3345874. DOI: 10.2147/CLEP.S28339. View

12.

Yoneda T, Sasaki A, Mundy G . Osteolytic bone metastasis in breast cancer. Breast Cancer Res Treat. 1994; 32(1):73-84. DOI: 10.1007/BF00666208. View

13.

Katzer A, Meenen N, Grabbe F, Rueger J . Surgery of skeletal metastases. Arch Orthop Trauma Surg. 2002; 122(5):251-8. DOI: 10.1007/s00402-001-0359-2. View

14.

Saad F, Gleason D, Murray R, Tchekmedyian S, Venner P, Lacombe L . A randomized, placebo-controlled trial of zoledronic acid in patients with hormone-refractory metastatic prostate carcinoma. J Natl Cancer Inst. 2002; 94(19):1458-68. DOI: 10.1093/jnci/94.19.1458. View

15.

Ward W, Holsenbeck S, Dorey F, Spang J, Howe D . Metastatic disease of the femur: surgical treatment. Clin Orthop Relat Res. 2003; (415 Suppl):S230-44. DOI: 10.1097/01.blo.0000093849.72468.82. View

16.

Spencer K, Parrish R, Barton R, Henry A . Palliative radiotherapy. BMJ. 2018; 360:k821. PMC: 5865075. DOI: 10.1136/bmj.k821. View

17.

Hartsell W, Scott C, Bruner D, Scarantino C, Ivker R, Roach 3rd M . Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst. 2005; 97(11):798-804. DOI: 10.1093/jnci/dji139. View

18.

Migliorati C, Epstein J, Abt E, Berenson J . Osteonecrosis of the jaw and bisphosphonates in cancer: a narrative review. Nat Rev Endocrinol. 2010; 7(1):34-42. DOI: 10.1038/nrendo.2010.195. View

19.

Selvaggi G, Scagliotti G . Management of bone metastases in cancer: a review. Crit Rev Oncol Hematol. 2005; 56(3):365-78. DOI: 10.1016/j.critrevonc.2005.03.011. View

20.

. 8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomised comparison with a multifraction schedule over 12 months of patient follow-up. Bone Pain Trial Working Party. Radiother Oncol. 1999; 52(2):111-21. View