Concurrent Capecitabine with External Beam Radiotherapy Versus Radiotherapy Alone in Painful Bone Metastasis of Breast Cancer Origin

Overview

Journal J Bone Oncol

Publisher Elsevier

Date 2021 Oct 29

PMID 34712554

Citations 1

Authors

Shimaa Ahmed

Shereen M Kamal

Tareq Salah

Mayada Fawzy Sedik

Ayatallah A Youssief

Affiliations

Soon will be listed here.

Abstract

Background: In breast cancer, painful bone metastases are common. Local radiotherapy is the standard treatment of painful bone metastases. Pain control and overall response rateswere low in radiotherapy alone.The objectives of this study were to compare the safety and efficacy of external beam radiotherapy with concurrent capecitabine vs. external beam radiotherapy alone in pain control of painful bone metastases in breast cancer patients.

Materials And Methods: Eighty-four patients with painful bone metastases from breast cancer participated in this prospective study. We randomized the patients into two groups: group A treated with radiotherapy 30 Gy in 10 fractions and group B treated with capecitabine 825 mg/m every 12 hrs. concurrently with the same radiotherapy dose.

Results: There was no statistically significant difference between the two groups regarding early treatment toxicity. Most of the toxicity was gastrointestinal (diarrhea and nausea) and mild (grade I or II). The median pain score decreased from week one, and there was a marked response at week4. The difference in median pain score between both groups was statistically significant with p-value = 0.045. The median analgesic score in both groups was statistically significant with a p-value = 0.032 at week 12. A complete response to pain at week 4 was 19% and 42.9% in groups A and B, respectively.

Conclusion: Concurrent chemoradiation in painful bone metastases from breast cancer origin was tolerable and safe; it had a higher overall response rate and pain palliation than radiotherapy alone.

Citing Articles

Bone Metastasis of Breast Cancer: Molecular Mechanisms and Therapeutic Strategies.

Pang L, Gan C, Xu J, Jia Y, Chai J, Huang R Cancers (Basel). 2022; 14(23).

PMID: 36497209 PMC: 9738274. DOI: 10.3390/cancers14235727.

References

Saito T, Yamaguchi K, Toya R, Oya N . Single- Versus Multiple-Fraction Radiation Therapy for Painful Bone Metastases: A Systematic Review and Meta-analysis of Nonrandomized Studies. Adv Radiat Oncol. 2019; 4(4):706-715. PMC: 6817531. DOI: 10.1016/j.adro.2019.06.003. View

Sathiakumar N, Delzell E, Morrisey M, Falkson C, Yong M, Chia V . Mortality following bone metastasis and skeletal-related events among women with breast cancer: a population-based analysis of U.S. Medicare beneficiaries, 1999-2006. Breast Cancer Res Treat. 2011; 131(1):231-8. DOI: 10.1007/s10549-011-1721-x. View

Macedo F, Ladeira K, Pinho F, Saraiva N, Bonito N, Pinto L . Bone Metastases: An Overview. Oncol Rev. 2017; 11(1):321. PMC: 5444408. DOI: 10.4081/oncol.2017.321. View

M Van der Velden J, van der Linden Y, Versteeg A, Verlaan J, Gerlich A, Pielkenrood B . Evaluation of effectiveness of palliative radiotherapy for bone metastases: a prospective cohort study. J Radiat Oncol. 2019; 7(4):325-333. PMC: 6290653. DOI: 10.1007/s13566-018-0363-6. View

Chow E, Harris K, Fan G, Tsao M, Sze W . Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol. 2007; 25(11):1423-36. DOI: 10.1200/JCO.2006.09.5281. View

Rich S, Chow R, Raman S, Zeng K, Lutz S, Lam H . Update of the systematic review of palliative radiation therapy fractionation for bone metastases. Radiother Oncol. 2018; 126(3):547-557. DOI: 10.1016/j.radonc.2018.01.003. View

Sze W, Shelley M, Held I, Wilt T, Mason M . Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy--a systematic review of randomised trials. Clin Oncol (R Coll Radiol). 2003; 15(6):345-52. DOI: 10.1016/s0936-6555(03)00113-4. View

Chow E, Hoskin P, Mitera G, Zeng L, Lutz S, Roos D . Update of the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases. Int J Radiat Oncol Biol Phys. 2011; 82(5):1730-7. DOI: 10.1016/j.ijrobp.2011.02.008. View

Sherry A, Mayer I, Ayala-Peacock D, Abramson V, Rexer B, Chakravarthy A . Combining Adjuvant Radiotherapy With Capecitabine in Chemotherapy-resistant Breast Cancer: Feasibility, Safety, and Toxicity. Clin Breast Cancer. 2020; 20(4):344-352.e1. DOI: 10.1016/j.clbc.2020.02.010. View

10.

Serlin R, Mendoza T, Nakamura Y, Edwards K, Cleeland C . When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain. 1995; 61(2):277-284. DOI: 10.1016/0304-3959(94)00178-H. View

11.

Foro Arnalot P, Fontanals A, Galceran J, Lynd F, Sanz Latiesas X, Rodriguez de Dios N . Randomized clinical trial with two palliative radiotherapy regimens in painful bone metastases: 30 Gy in 10 fractions compared with 8 Gy in single fraction. Radiother Oncol. 2008; 89(2):150-5. DOI: 10.1016/j.radonc.2008.05.018. View

12.

Wu J, Wong R, Johnston M, Bezjak A, Whelan T . Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol Biol Phys. 2003; 55(3):594-605. DOI: 10.1016/s0360-3016(02)04147-0. View

13.

McDonald R, Ding K, Brundage M, Meyer R, Nabid A, Chabot P . Effect of Radiotherapy on Painful Bone Metastases: A Secondary Analysis of the NCIC Clinical Trials Group Symptom Control Trial SC.23. JAMA Oncol. 2017; 3(7):953-959. PMC: 5547919. DOI: 10.1001/jamaoncol.2016.6770. View

14.

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

15.

Rades D, Dunst J, Schild S . The first score predicting overall survival in patients with metastatic spinal cord compression. Cancer. 2007; 112(1):157-61. DOI: 10.1002/cncr.23150. View

16.

Strom H, Bremnes R, Sundstrom S, Helbekkmo N, Flotten O, Aasebo U . Concurrent palliative chemoradiation leads to survival and quality of life benefits in poor prognosis stage III non-small-cell lung cancer: a randomised trial by the Norwegian Lung Cancer Study Group. Br J Cancer. 2013; 109(6):1467-75. PMC: 3776981. DOI: 10.1038/bjc.2013.466. View

17.

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

18.

Ikeda E, Kojima T, Kaneko K, Minashi K, Onozawa M, Nihei K . Efficacy of concurrent chemoradiotherapy as a palliative treatment in stage IVB esophageal cancer patients with dysphagia. Jpn J Clin Oncol. 2011; 41(8):964-72. DOI: 10.1093/jjco/hyr088. View

19.

Goblirsch M, Zwolak P, Clohisy D . Biology of bone cancer pain. Clin Cancer Res. 2006; 12(20 Pt 2):6231s-6235s. DOI: 10.1158/1078-0432.CCR-06-0682. View

20.

Yin W, Pei G, Liu G, Huang L, Gao S, Feng X . Efficacy and safety of capecitabine-based first-line chemotherapy in advanced or metastatic breast cancer: a meta-analysis of randomised controlled trials. Oncotarget. 2015; 6(36):39365-72. PMC: 4770778. DOI: 10.18632/oncotarget.5460. View