The role of radiation therapy in bone metastases management (original) (raw)
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Radiotherapy for Bone Metastases
Journal of Pain and Symptom Management, 1999
Pain from bone metastases is a common problem in patients with advanced cancer, and radiotherapy plays an important role in its palliation. Single fraction treatments are often prescribed, but there is no clear consensus on this issue and clinical practice shows significant variability. This situation is unsatisfactory for all parties—the patient, the clinician, and the health care administrator. Randomized trials may use poor outcome measures and this contributes to practice variability. The credibility of outcome studies is often reduced due to poor study design, small sample sizes, and the use of endpoints that are both unreliable and unsuitable. The endpoints used have been narrowly defined, the patient’s perspective has generally been overlooked, and quality of life has only once been used as an endpoint. A review of the current literature suggests that instruments specific to bone metastases are required. These must be based on patient experience, and rely on self-report. In addition, there is a need to understand the relative priority that patients attribute to treatment outcomes. The use of better instruments and methodologies in future trials will enhance the credibility of results and reduce practice variations.
CONTROVERSIES IN RADIOTHERAPY OF METASTATIC BONE DISEASE
Metastatic bone (MB) disease is a common manifestation of advanced cancer. Although bone metastases can be asymptomatic, in more than two thirds of patients they cause pain, as well as a wide spectrum of complications, including pathological fractures, spinal cord and nerve root compressions, hypercalcaemia and mobility impairment; greatly reducing the patients' quality of life. Radiotherapy has since long proved to be an effective modality for treatment of bone metastases, resulting in palliation in up to 80% patients. Despite the extensive research in this area, many controversial issues still remain. The authors conducted a critical review of the publications on several of these issues, including the mechanisms of action of radiotherapy, dose-response relationship, optimal fractionation regimens, irradiation techniques, response assessment. The conclusion was drawn that in line with the current clinical evidence, there are no substantial differences between various fractionation schedules in terms of analgesic effect. However, in consideration of other endpoints, MF regimens may provide better effect than SF; this is a subject for future clinical research. Currently, besides the clinical evidence, the routine practice in radiotherapy departments is strongly influenced by other disease-non-specific factors, including the factors that are physician-related (country of training, location, and type of practice, professional membership affiliation, etc.) and policy/community-related (type of reimbursement, available recourses). A brief description of the practice in palliative radiotherapy for bone metastases in the Radiotherapy Department of the National Center of Oncology is presented.
European Surgical Orthopaedics and Traumatology, 2014
Bone metastases are only apparently similar lesions, considering the large varieties of istotypes and the spread of the primary tumour. Although these metastases develop early and are not terminal events, they have to be considered as severe complications. When possible, surgical treatment can improve the history of the patient in terms of life expectancy and quality of life. The approach to these lesions should be multidisciplinary in collaboration with oncologists and radiotherapists. In fact the average of survival of these patients has increased in recent years. The evolution of anesthesiological techniques permits surgical treatments that once were considered prohibitive. The application of new adjuvant therapies increases the effectiveness for surgical treatment. Controversy exists over the most appropriate treatment for patients with bone metastatic disease. The purpose was to determine the best sequential process to arrive at the most appropriate treatment considering the individual general conditions and the parameters of the metastases. As the number of treatment options for metastatic bone disease has grown, it has become clear that effective implementation of these treatments can only be achieved by a multidisciplinary approach.
New Paradigms of Radiotherapy for Bone Metastasis
Radiotherapy, 2017
Proper care of patients with bone metastasis requires interdisciplinary treatments. Radiotherapy (RT) plays a central role in the management of painful bone metastasis. External beam RT can provide rapid successful palliation of painful bone metastasis in 50-80% of patients, is associated with very few adverse effects and leads to complete pain relief at the treated site in up to one-third of patients. Intensity-modulated RT (IMRT) or stereotactic body RT (SBRT) enables the delivery of higher doses to the target tumor while minimizing the dose to adjacent organs. Reirradiation using IMRT or SBRT is a valuable option for the management of bone metastases. A multidisciplinary team, especially one consisting of a spinal surgeon and rehabilitation physician, is particularly useful for treating patients with spinal bone metastases characterized by spinal instability. Rehabilitation intervention which increases the physical activity level and prevents deconditioning is important. Future developments in surgical procedures and RT will likely improve the management protocols for bone metastases and technology to reduce metal artifacts in radiation planning might improve the efficacy and safety of combination therapy.
Interventional Radiologist's perspective on the management of bone metastatic disease
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2015
Bone metastases can be treated by interventional radiologists with a minimally invasive approach. Such treatments are performed percutaneously under radiological imaging guidance. Different interventional techniques can be applied with curative or palliative intent depending on lesions and patients' status. In the whole, available interventional techniques are distinguished into "ablative" and "consolidative". Ablative techniques achieve bone tumor necrosis by dramatically increasing or decreasing intra-tumoral temperature. This option can be performed in order to alleviate pain or to eradicate the lesion. On the other hand, consolidative techniques aim at obtaining bone defect reinforcement mainly to alleviate pain and prevent pathological fractures. We herein present evidence supporting the application of each different interventional technique, as well as common strategies followed by interventional radiologists while approaching bone metastases.
Supportive Care in Cancer, 2007
Introduction Since the 1980s, randomized clinical trials showed that single fraction radiotherapy (RT) provided equal pain relief as multiple fractions of RT in the treatment of bone metastases. Materials and methods Using Medline, a literature search was conducted on patterns of practice among radiation oncologists and patients’ preferences of dose fractionations for the treatment of bone metastases. Results and discussion Fifteen studies on international patterns of practice published between 1966 and May 2006 were identified. Surveys of Canadian radiation oncologists indicated approximately 85% preferred multiple fractions, most often as 20 Gray in five fractions (20 Gy/5). Surveys in the United States indicated that 30 Gy/10 was most commonly used, and 90–100% of these oncologists preferred multiple over single fraction RT. Multiple fractions were most commonly used in the United Kingdom, Western Europe, Australia and New Zealand, and India; however, more radiation oncologists in these countries would prescribe a single fraction than in North America. Three studies investigated patients’ preferences of dose fractionations. In the Australian study, most patients favored single fraction RT as long as long-term outcomes were not compromised. Durability of pain relief was considered more important than short-term convenience factors. In the Singapore study, 85% of patients would choose extended courses of RT (24 Gy/6) compared to a single 8 Gy. In the Canadian study, most patients (76%) would choose a single 8 Gy over 20 Gy/5 of palliative RT due to greater convenience. Conclusion Despite strong evidence supporting the use of single fraction RT, current practices and preferences favor multiple fractions for the treatment of bone metastases. This has significant implications for the overall quality of life, RT department workload, costs to healthcare systems, and patient convenience.
Background:- Palliative radiotherapy has proven to be successful in treating pain caused by metastatic lesions in any bone. In most prospective randomized trials on radiotherapy for bone pain, responses up to 70% were reported. However, when survival was prolonged, recurrent pain was reported in up to 50% of patients. It is to be expected for the future, since patients are living longer with disseminated disease, that symptoms may recur & therefore retreatment of bone metastases for palliative reasons will increase. The aim of the study:- Is to evaluate the efficacy and safety of re-irradiation for painful bone metastasis comparing different fractionation regimens with an assessment of subjective response & toxicity. Patient and methods:-one hundred and twenty patients with bone metastasis or bone pain with previous irradiation were included in this prospective randomized study comparing 8 and 6 Gy single fraction with multiple fractions 3 Gy in 10 fractions and 4 Gy in 5 fractions. The primary end point of treatment was the relief of pain, improvement of quality of life. However, the secondary end point was comparing the short term side effects of these treatment regimens. The results:- pain response: after 2 weeks, complete response was observed in 23.3% in group I, 13.3% in group II, III & 20% in group IV and partial response in 66.7% in group I, 73.3% in group II, 76.7% in group III & 70% in group IV. After 4 weeks, complete response was observed in 23.3%, in group I, III & IV while 16.7% only in group II and partial response in 70 % in group I, IV & and 73.3% in group II, III. After 8 weeks as shown in table 4, complete response was observed in 26.7% in group I, 23.3% in group II, 33.3% in group III & 30% in group IV and partial response in 70% in the group I&II, 63.3% in group III & 66.7 % in group IV. no significant difference in pain response was observed between the four groups. Analgesic requirement after 8 weeks of radiotherapy: patients that complained of pain that required strong narcotic decreased in group I: from 10 to 5, group II: from 13 to 6, group III: from 13 to 5, group IV: from 12 to 6. Patients with karnofsky p.s. 90-100 increased from 0 to 1 in all groups while patients of karnofsky p.s. 70-80 increased from 8 to 23 and from 10 to 22, from 12 to 25 and from 9 to 22 in group I, II, III and IV respectively. Evaluation of acute toxicity: treatment was tolerated in all groups, as, grade I diarrhea occur only in 1 patient in group I and II & dermatitis occur in 3 patients, 1 in each group I, II, and III . Conclusion:- the results of our study seem to confirm that there no significant difference between the four regimens of dose fractionation of external beam radiotherapy (8 Gy single fraction, 6 Gy single fraction ,30 Gy in ten fractions and 20 Gy in five fractions) in palliative treatment of bone metastasis as regard pain relief so the use of 8 Gy single fraction of radiotherapy may be of benefit for the patient by reducing treatment time and cost also reducing the treatment burden for hospital, stuff and equipment.
Systemic Therapy for Bone Metastases
Cancer Control, 2012
Background Accelerated bone loss in patients with cancer is a frequent problem that may result from invasion of the cancer to bone, paraneoplastic tumor proteins, and/or hormonal therapies utilized for cancer treatment. Patients with osteolytic bone disease from multiple myeloma and bone metastases from solid tumors may develop a vicious cycle of bone destruction involving both osteolytic and osteoblastic effects. Consequently, a variety of skeletal-related events (SREs) may occur, including pathological fractures, hypercalcemia, spinal cord compression, and the need for surgical intervention and radiation therapy. Methods This article reviews the results of trials that investigated the safety and efficacy of pharmacologic agents, including bisphosphonates and denosumab, for treatment of bone metastases. This analysis is derived from an assessment of the medical literature. Results Beneficial systemic therapies for bone metastases have been developed to decrease SREs. Possible antit...
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Multimodal Treatment of Bone Metastasis—A Surgical Perspective
Frontiers in Endocrinology
Over the past decades there has been an increase in the incidence of cancer worldwide. With the advancement in treatment, patient survival has improved in tandem with the increasing incidence. This, together with the availability of advanced modern diagnostic modalities, has resulted in more cases of metastatic bone disease being identified. Bone metastasis is an ongoing problem and has significant morbidity implications for patients affected. Multimodal treatment strategies are required in dealing with metastatic bone disease, which include both surgical and non-surgical treatment options. In the multidisciplinary team, orthopedic surgeons play an important role in improving the quality of life of cancer patients. Surgical intervention in this setting is aimed at pain relief, restoration of function and improvement in functional independence. In selected cases with resectable solitary metastasis, surgical treatment may be curative. With the advancement of surgical technique and improvement in implant design and manufacture, a vast array of surgical options are available in the modern orthopedic arena. In the majority of cases, limb salvage procedures have become the standard of care in the treatment of metastatic bone disease. Non-surgical adjuvant treatment also contributes significantly to the improvement of cancer patient care. A multidisciplinary approach in this setting is of paramount importance.
Photodynamic therapy outcome modelling for patients with spinal metastases: a simulation-based study
Scientific Reports
Spinal metastases often occur in the advanced stages of breast, lung or prostate cancer, resulting in a significant impact on the patient’s quality of life. Current treatment modalities for spinal metastases include both systemic and localized treatments that aim to decrease pain, improve mobility and structural stability, and control tumour growth. With the development of non-toxic photosensitizer drugs, photodynamic therapy (PDT) has shown promise as a minimally invasive non-thermal alternative in oncology, including for spinal metastases. To apply PDT to spinal metastases, predictive algorithms that optimize tumour treatment and minimize the risk of spinal cord damage are needed to assess the feasibility of the treatment and encourage a broad acceptance of PDT in clinical trials. This work presents a framework for PDT modelling and planning, and simulates the feasibility of using a BPD-MA mediated PDT to treat bone metastases at two different wavelengths (690 nm and 565 nm). An o...
Scientific Reports
Cyclin dependent kinases 4/6 (CDK4/6) inhibitors gained an essential role in the treatment of metastatic breast cancer. Nevertheless, data regarding their use in combination with radiotherapy are still scarce. We performed a retrospective preliminary analysis of breast cancer patients treated at our Center with palliative radiation therapy and concurrent CDK4/6 inhibitors. Toxicities were measured according to CTCAE 4.0, local response according to RECIST 1.1 or PERCIST 1.0 and pain control using verbal numeric scale. 18 patients (32 treated sites) were identified; 50% received palbociclib, 33.3% ribociclib and 16.7% abemacliclib. Acute non-hematologic toxicity was fair, with the only exception of a patient who developed G3 ileitis. During 3 months following RT, 61.1% of patients developed G 3–4 neutropenia; nevertheless no patient required permanent suspension of treatment. Pain control was complete in 88.2% of patients three months after radiotherapy; 94.4% of patients achieved an...
Assessing the Mechanical Weakness of Vertebrae Affected by Primary Tumors: A Feasibility Study
Materials, 2020
Patients spend months between the primary spinal tumor diagnosis and the surgical treatment, due to the need for performing chemotherapy and/or radiotherapy. During this period, they are exposed to an unknown risk of fracture. The aim of this study was to assess if it is possible to measure the mechanical strain in vertebrae affected by primary tumors, so as to open the way to an evidence-based scoring or prediction tool. We performed biomechanical tests on three vertebrae with bone tumor removed from patients. The tests were designed so as not to compromise the standard surgical and diagnostic procedures. Non-destructive mechanical tests in combination with state-of-the-art digital image correlation allowed to measure the distribution of strain on the surface of the vertebra. Our study has shown that the strains in the tumor region is circa 3 times higher than in the healthy bones, with principal strain peaks of 40,000/−20,000 microstrain, indicating a stress concentration potentia...
A Tailored Approach for Appendicular Impending and Pathologic Fractures in Solid Cancer Metastases
Cancers, 2022
Simple Summary Patients with bone metastases often suffer with complications, such as bone fractures, which have a substantial negative impact on clinical outcomes. To optimize clinical results, a tailored approach should be defined for managing impending or pathologic fractures in each individual case. The ability to control systemic disease, the extent, location and nature of bone metastases, and the biology of the underlying tumor, are the main factors that will define the strategy to follow. Abstract Advances in medical and surgical treatment have played a major role in increasing the survival rates of cancer patients with metastatic bone disease. The clinical course of patients with bone metastases is often impaired by bone complications, such as bone fractures, which have a substantial negative impact on clinical outcomes. To optimize clinical results and prevent a detrimental impact on patients’ health, a tailored approach should be defined for any given patient. The optimal ...
Journal of Health Sciences and Medicine, 2020
Introduction: Bone metastasis is the first finding in 10-15% of cancer patients and seen in 30-90% of patients with cancer. Bone metastases are one of the most common causes of cancer-related pain. Radiotherapy (RT) is one of the first preferred palliation methods in bone metastases because it provides pain palliation in a short time, prevents the development of pathological fractures and creates minimal side effects. The aim of this study was to evaluate the diagnosis, demographic distribution and numerical status of patients with bone metastases who received palliative RT in terms of single center experiences. Material and Method: Patients who received palliative bone RT in Radiation Oncology Clinic Between January 2016 and September 2019 were included in the study. The Hospital Information Management System data of these patients were retrospectively scanned and the records obtained were used. All records were compared with the files in the archives and confirmed. The profiles, sex, age, histologic type, treatment schedule and fraction numbers of the patients who underwent radiotherapy for palliative purposes were retrospectively evaluated. Results: In this study, 1469 (14%) palliative bone RT patients of 10254 total radiotherapy patients were evaluated. In the last two years, there was no proportional decrease in the number of patients who received palliative bone RT. 48% of patients were female and 52% were male. According to the primary tumor distributions; breast cancers (31%), prostate cancers (17%), primary unknown cancers (15%), lung cancer (15%), GIS cancers (9%), bladder cancers (4%) and other cancers (10%). The median age of the patients was 60 (range 13-93). In the last 4 years, the most frequent 7 cancer diagnoses didn't show any significant gender and year-based changes. 888 palliative bone RT patients were treated with 2-5 fractions (60%), 420 patients with 6-10 fractions (29%) and 161 patients with single fraction (11%). There were also no significant changes in treatment schemes. The ratio of different dose-fraction schemes in our study is consistent with the literature. Conclusion: Optimal dose and fraction schemes are highly variable for palliative RT in patients with bone metastases. In light of these results, when deciding on palliative RT dose-fraction scheme; patient characteristics, treatment interactions, physical conditions, workload and economic costs should be taken into consideration. Palliative RT is the standard procedure in most patients with bone metastases because of its high palliation rate, short-term application, low toxicity and low re-application.
Surgical Neurology International
Background: Surgical treatment of spinal metastases should be tailored to provide pain control, neurological deficit improvement, and vertebral stability with low operative morbidity and mortality. The aim of this study was to analyze the predictive value of some preoperative factors on overall survival in patients undergoing surgery for spinal metastases. Methods: We retrospectively analyzed a consecutive series of 81 patients who underwent surgery for spinal metastases from 2015 and 2021 in the Clinic of Neurosurgery of Ancona (Italy). Data regarding patients’ baseline characteristics, preoperative Karnofsky Performance Status Score (KPS), and Frankel classification grading system, histology of primary tumor, Tokuhashi revised and Tomita scores, Spine Instability Neoplastic Score, and Epidural Spinal Cord Compression Classification were collected. We also evaluated the interval time between the diagnosis of the primary tumor and the onset of spinal metastasis, the type of surgery,...
Effects of radiotherapy and short-term starvation combination on metastatic and non-tumor cell lines
DNA Repair, 2020
Background: Since its discovery in the late 19 th century, radiotherapy has been one of the most important medical treatments in oncology. Recently, fasting or short-term starvation (STS) in cancer patients undergoing chemotherapy has been studied to determine its potential for enhancing the therapeutic index and for preventing sideeffects, but no data are available in the radiotherapy setting. We thus decided to investigate the effects in vitro of STS in combination with radiotherapy in metastatic cancer cells and non-cancer cells. Methods: Cells were incubated in short-term starvation medium (STS medium, 0⋅5 g/L glucose + 1% FBS) or in control medium (CM medium, 1 g/L glucose + 10 % FBS) for 24 h and then treated with single high-dose radiation. A plexiglass custom-built phantom was used to irradiate cells. DNA damage was evaluated using alkaline comet assay and theCometAnalyser software. The cell surviving fraction was assessed by clonogenic assay. Finding: STS followed by single high-dose radiation significantly increased DNA damage in metastatic cancer cell lines but not in normal cells. Furthermore, STS reduced the surviving fraction of irradiated tumor cells, indicating a good radio-sensitizing effect on metastatic cell lines. This effect was not observed in non-tumor cells. Interpretation: Our results suggest that STS may alter cellular processes, enhancing the efficacy of radiotherapy in metastatic cancer cellsin vitro. Interestingly, STS has radioprotective effect on the survival of healthy cells.
New WHO guidelines for cancer pain in adults and adolescents
Research and Practical Medicine Journal, 2021
In this article we performed publication analysis devoted to pain medicine in oncology during anticancer therapy and in palliative setting. Until recently, the main WHO guidelines for pain management in oncology were the recommendations of 1996, which included only pain relievers, as well as adjuvant and symptomatic drugs, which were applied according to the WHO analgesic ladder. These recommendations were based on the collective expert opinion of leading clinicians and scientists. The new WHO clinical guidelines were published in 2019. They are based on the principles of evidence-based medicine, including modern concepts of the etiology and pathogenesis of tumor pain syndrome. This recommendations contain sections on the analgesic efficacy of radiation therapy and antitumor drug therapy. The new WHO recommendations have not yet been published in Russian and are not sufficiently available for a wide range of oncologists and palliative specialists in our country. The purpose of this ...
uPAR antibody (huATN-658) and Zometa reduce breast cancer growth and skeletal lesions
Bone Research, 2020
Urokinase plasminogen activator receptor (uPAR) is implicated in tumor growth and metastasis due to its ability to activate latent growth factors, proteases, and different oncogenic signaling pathways upon binding to different ligands. Elevated uPAR expression is correlated with the increased aggressiveness of cancer cells, which led to its credentialing as an attractive diagnostic and therapeutic target in advanced solid cancer. Here, we examine the antitumor effects of a humanized anti-uPAR antibody (huATN-658) alone and in combination with the approved bisphosphonate Zometa (Zoledronic acid) on skeletal lesion through a series of studies in vitro and in vivo. Treatment with huATN-658 or Zometa alone significantly decreased human MDA-MB-231 cell proliferation and invasion in vitro, effects which were more pronounced when huATN-658 was combined with Zometa. In vivo studies demonstrated that huATN-658 treatment significantly reduced MDA-MB-231 primary tumor growth compared with cont...
Diagnostics
Metastasis to bone is a common occurrence among epithelial tumors, with a high incidence rate in the Western world. As a result, bone lesions are a significant burden on the healthcare system, with a high morbidity index. These injuries are often symptomatic and can lead to functional limitations, which in turn cause reduced mobility in patients. Additionally, they can lead to secondary complications such as pathological fractures, spinal cord compression, hypercalcemia, or bone marrow suppression. The treatment of bone metastases requires collaboration between multiple healthcare professionals, including oncologists, orthopedists, neurosurgeons, physiatrists, and radiotherapists. The primary objective of this study is to evaluate the correlation between two methods used to assess local control. Specifically, the study aims to determine if a reduction in the volume of bone lesions corresponds to better symptomatic control in the clinical management of patients, and vice versa. To ac...
Recent Advances in the Treatment of Bone Metastases and Primary Bone Tumors: An Up-to-Date Review
Cancers, 2021
In the last decades, the treatment of primary and secondary bone tumors has faced a slow-down in its development, being mainly based on chemotherapy, radiotherapy, and surgical interventions. However, these conventional therapeutic strategies present a series of disadvantages (e.g., multidrug resistance, tumor recurrence, severe side effects, formation of large bone defects), which limit their application and efficacy. In recent years, these procedures were combined with several adjuvant therapies, with different degrees of success. To overcome the drawbacks of current therapies and improve treatment outcomes, other strategies started being investigated, like carrier-mediated drug delivery, bone substitutes for repairing bone defects, and multifunctional scaffolds with bone tissue regeneration and antitumor properties. Thus, this paper aims to present the types of bone tumors and their current treatment approaches, further focusing on the recent advances in new therapeutic alternati...
Radiation therapy in veterinary medicine: a practical review
Companion Animal, 2020
Radiotherapy is a treatment modality based on the use of high-energy rays to kill neoplastic cells, which has become an integral therapeutic tool in veterinary medicine. Radiotherapy may be an effective treatment for tumours that are not easily managed with surgery or with chemotherapy, even for patients with advanced-stage neoplasia. Novel uses of radiotherapy include rescue therapy for specific benign conditions that are refractory to conventional therapy. Acute and late toxicities depend on the prescribed protocol as well as sensitivity and volume of the normal tissue in or near the radiation field. The potential risks associated with the treatment should be fully discussed with owners before starting radiotherapy. New hardware and software technology has drastically advanced the ability to precisely target tumours, improving treatment efficacy and safety.
Journal of Health Sciences and Medicine
Aim: To assess oncological outcomes and adverse events of patients receiving single or multi-fraction stereotactic body radiotherapy (SBRT) for spine metastases. Material and Method: Patients with any pathologically proven solid tumor histology who had SBRT to the spine for recurrent or metastatic disease between the years 2010 and 2021 at our department were identified from institutional database. Patient, tumor and treatment characteristics, and follow-up medical records were retrospectively reviewed. Local control (LC) and overall survival (OS) rates were calculated, and adverse events were evaluated. Results: A total of 47 patients were treated to 50 spine metastases. Median age was 53 years for all patients. Histologies included breast cancer (45%), non-small cell lung cancer (NSCLC; 21%), prostate cancer (15%) and other types (19%). Median follow-up was 16 months for all patients. Of 47 patients, six (13%) developed local failure and 15 (32%) died without local failure. One an...
Palliative Radiation Therapy in Symptom Management of Advanced Cancer
Onkologie, 2021
Úvod: Radioterapie patří mezi základní modality onkologické léčby a může významně přispět k ovlivnění lokální kontroly a ke zmírnění symptomů pokročilého nádorového onemocnění. Soubor pacientů a metody: Bylo provedeno retrospektivní vyhodnocení efektu (podle dopadu na zmírnění symptomů a dle zobrazovacích metod) a toxicity (podle kritérií Radiation Therapy Oncology Group-RTOG) paliativní radioterapie u pacientů více radioterapeutických pracovišť: Onkologická klinika 1. LF UK a VFN v Praze (OK VFN), Ústav radiační onkologie 1. LF UK a Nemocnice Na Bulovce v Praze (ÚRO NNB) a Onkologická klinika 2. LF UK a FN Motol v Praze (OK FNM). Výsledky: Ve dvou souborech pacientů byla provedena radioterapie s paliativním záměrem na oblast primárního tumoru plic, úleva od obtíží byla zaznamenána u 22 (75,9 %) (OK VFN), resp. u 38 (64,4 %) (ÚRO NNB) pacientů. Na oblast kostních metastáz různých primárních diagnóz bylo ozářeno 91 pacientů (OK VFN); analgetický efekt byl zaznamenán v 72 (79,2 %) případech. Po radioterapii na oblast mozku (OK FNM) pro metastatické postižení byl zjištěn větší profit u pacientů v celkově lepším stavu (Karnofsky index > 70 %) oproti pacientům s Karnofského indexem < 70 %-přežití 6 měsíců po léčbě činilo 40 %, resp. 5 %. Ve skupině pacientek s lokálně pokročilým karcinomem hrdla děložního (ÚRO NNB) byl pozorován efekt na zmírnění symptomů (bolesti, krvácení) v 18 (69,2 %) případech a byl pozorován přínos pro přežití v podskupině pacientek ozářených vyšší dávkou záření. Závěr: Paliativní radioterapie přináší benefit pacientům s pokročilým nádorovým onemocněním. V našich souborech poskytla tato metoda výbornou kontrolu symptomů, toxicita léčby byla minimální. Klíčová slova: paliativní radioterapie, paliativní péče, radioterapie, karcinom plic, kostní metastázy, mozkové metastázy, karcinom děložního hrdla. Palliative Radiation Therapy in Symptom Management of Advanced Cancer Background: Radiotherapy is a mainstay of oncology treatment. This method improves local control of disease and relieves symptoms of metastatic cancer. Patients and methods: The effect (according to symptom palliation and imaging methods) and toxicity (according to Radiation Therapy Oncology Group criteria) of palliative radiotherapy were evaluated in several groups of patients from more departments:
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Surgical therapy of bone metastases
Seminars in oncology, 2007
The treatment of patients with cancer epitomizes the importance of using a collaborative team approach to optimize patient care. Physician team members most commonly are radiation oncologists, general surgeons, surgical oncologists, thoracic surgeons, neurosurgeons, and orthopedic surgeons. When patients are receiving chemotherapy, their medical oncologist frequently takes responsibility for coordinating care among the various team members and initiating consultations with necessary providers. When patients develop bone metastases or chemotherapy-induced bone loss (CTIBL), the orthopedic surgeon may be able to improve the patient's quality of life greatly. Procedures orthopedists perform most commonly include open reduction and internal fixations and arthroplasties (joint replacement surgery). Less invasive procedures currently being tested include stereotactic radiosurgery, radiofrequency ablation (RFA), and percutaneous cementoplasty. By understanding the options available to ...
Tumori
Radiotherapy has an established palliative role for bone metastases but despite the large number of patients treated there is still controversy surrounding the optimal radiotherapy schedule to prescribe. The aim of this survey was to determine the decision patterns of Italian radiation oncologists in four different clinical cases of patients with bone metastases. During the latest national meeting of the Italian Association of Radiation Oncology (AIRO), four clinical cases were presented to attending radiation oncologists. The cases were different with respect to the histology of the primary tumor, performance status, pain before and after analgesics, tumor site, and radiological characteristics of the metastatic lesions. For each clinical case the respondents were asked to give an indication for treatment; prescribe doses, volumes and treatment field arrangements; decide whether to prescribe prophylactic supportive therapy or not; and provide information about factors that particul...
Radiation therapy for the management of painful bone metastases: Results from a randomized trial
Reports of Practical Oncology & Radiotherapy, 2014
The aim of this study was to compare the effectiveness of two radiotherapy schedules in patients with bone metastases. Background: We analyzed the need for re-irradiation, rates of pain control, pathological fractures, and functionality in patients randomized to single-fraction (8 Gy 1×) or multiplefraction radiotherapy (3 Gy 10×) with at least 12 months follow-up, during five years. The hypothesis was that the two radiotherapy schedules are equally effective. Materials and methods: Ninety patients with painful skeletal metastases were randomized to receive single fraction (8 Gy) or multiple fraction (3 Gy 10×) radiotherapy. Results: In the single-fraction group, seven pathological fractures occurred (15.5%) versus two (4.4%) in the multiple-fraction group. There was no statistically significant difference between the time it took to suffer a pathological fracture in both groups (p = 0.099). Patients in the single-fraction group received twelve re-irradiations (26.6%), four in the multiplefraction group (8.8%), with no significant difference between time elapsed before the first re-irradiation (p = 0.438). Conclusion: This study shows no difference between the two groups for the majority of patients with painful bone metastases. Patients were followed up during five years, and the trial showed no disadvantage for 8 Gy 1× compared to 3 Gy 10×. Despite the fact that the pathological fracture rate is 3.75 times higher in the single-fraction group, this schedule is considered more convenient for patients and more cost-effective for radiotherapy departments.
Treatment of Metastatic Bone Disease
Kluwer Academic Publishers eBooks, 2006
Few skeletal metastases require surgical intervention. Radiotherapy, chemotherapy or both often provide symptomatic relief. An impending or actual pathologic fracture requires operative fixation because fractures through a tumor-bearing bone rarely heal without such intervention. The goals of fixation are to relieve pain, improve function and ambulation, facilitate medical and nursing care, and improve psychological well-being (Figures 11.1 and 11.2). The primary functional goal of surgical intervention is to allow immediate weight-bearing. Surgery should be avoided if this cannot be achieved. A variety of techniques, including prosthetic reconstruction (especially about the hip) or a combination of internal fixation combined with polymethyl methacrylate (PMMA), provides immediate fixation and stability. After the wound has healed, radiotherapy is usually used to arrest local tumor growth, permit bony repair, and prevent re-growth of tumor around the fixation device. This chapter discusses the techniques of treatment of long bone metastases.
Treatment of painful bone metastases
Nature Reviews Clinical Oncology, 2010
Bone metastases are the most common cause of cancer-related pain. Radiotherapy is a safe and effective therapy and is well established for such a situation. A fractionation regimen with a short overall treatment time (≤1 week) would be preferred if it was as effective as longer courses (2-4 weeks). Randomized clinical trials and meta-analyses have demonstrated that single-fraction radiotherapy with 1 × 8 Gy is as effective for pain relief as multi-fraction regimens such as 5 × 4 Gy in 1 week or 10 × 3 Gy in 2 weeks. Re-irradiation for recurrent pain in the irradiated region is required more often after single-fraction radiotherapy than multi-fraction radiotherapy; however, re-irradiation following single-fraction radiotherapy is safe and effective. Thus, 1 × 8 Gy is considered the standard regimen for uncomplicated painful bone metastases without pathological fractures or spinal cord compression. Multi-fraction radiotherapy results in significantly better remineralization of the osteolytic bone than single-fraction radiotherapy. Remineralization is important for preventing or treating pathological fractures. Multi-fraction long-course radiotherapy results in fewer recurrences of spinal-cord compression within the irradiated spinal region. Thus, long-course multi-fraction radiotherapy should be reserved for patients with a relatively favorable survival prognosis.
Management of metastatic bone disease
Metastatic bone disease is a common cause of pain and disability for patients with advanced cancer. Early detection and appropriate management can limit pain, reduce disability and prevent complications such as hypercalcaemia, pathological fracture and spinal cord compression. In specific cases surgical resection of an isolated bone metastasis may improve survival. This article provides an evidence-based overview of the investigation and management of patients with metastatic bone disease.
The use of palliative radiotherapy for bone metastasis
Radiotherapy and Oncology, 2010
Background: The value of palliative radiotherapy (PRT) for bone metastases is well established, but little is known about its use in the general population. Purpose: To describe the use of PRT for bone metastases in Ontario. Materials and methods: This was a retrospective cohort study. Treatment records from all Ontario RT departments were linked to a population-based cancer registry to describe the use of PRT. Results: 12.2% of the 434,241 patients, who died of cancer in Ontario between 1984 and 2004, received at least one course of PRT for bone metastases in the last 2 years of life. The rate of use of PRT varied across the province (inter-county range, 8.2-18.6%). Older patients and residents of poorer areas were less likely to receive PRT (p < 0.0001). Patients diagnosed with cancer in a hospital with a radiotherapy facility and those who lived closer to a radiotherapy centre were more likely to receive PRT (p < 0.0001). Over the study period, the use of PRT decreased in breast cancer and myeloma, but increased in prostate cancer (p < 0.0001).
Novel therapeutic approaches to cancer patients with bone metastasis
Critical Reviews in Oncology/Hematology, 2001
are warranted in order to reduce the incidence of bone metastases and to palliative established skeletal disease. External beam radiation therapy, endocrine treatments, chemotherapy, bisphosphonates and radioisotopes are all important. Bisphosphonates have become the treatment of choice for tumor-induced hypercalcaemia and more recently they have been used alone or in combination with cytotoxic agents in the palliative treatment of patients with bone metastases. The results are encouraging. Currently, new bisphosphonates that are a hundred times more powerful with respect to clodronate and pamidronate are under investigation. The treatment of metastases to bone and mechanisms of pain relief after radiation therapy are poorly understood. Up to date, there are not standard criteria for the irradiation of bone metastases and bone pain relief may be reached using a variety of fractionation schemes. Radionuclide therapy is the systemic use of radioisotopes for bone pain. It is currently regarded as suitable for comparison with wide-field irradiation, but appears to have major disadvantages in terms of pain relief and toxicity.
Middle East Journal of Cancer, 2021
Background: Bone metastases are believed to be the complications of cancer occurring in 20–75% of patients with advanced tumors. EBRT is recommended in case of symptomatic bone metastases. Preventing SREs and pain through early treatment of bone metastases is to be studied. We conducted the present study to investigate EBRT in asymptomatic bone metastases. Method: A retrospective cohort study for patients with bone metastases without symptoms, who were treated with EBRT, formed group A. Group B comprised the patients who did not receive EBRT. The time from diagnosis to onset of the 1st SRE was recorded for both groups. The follow-up period was 3 years. Pain was moderate to severe when rated as 5/10. Results: Asymptomatic bone metastases were found in 200 patients. They were free from pain or pathological fractures. They were divided into two groups of A and B. The overall demographics and disease characteristics were well-balanced for the two groups. The two groups were more or less...
Anticancer research, 2014
Our aim was to evaluate retrospectively the role of the radiotherapy in the multi-disciplinary management of pain due to bone metastases. A total of 305 patients received radiotherapy with or without bisphosphonate and antalgic drugs. Tolerability and efficacy were evaluated using a Numerical Rating Scale, Pain Intensity Difference evaluation scale related to administration of the drug, a 5-point verbal scale of the patients' general impression. We found differences in some patient subgroups: pain reduction was significantly more evident in patients treated with a single-fraction radiotherapy scheme. Overall, 68% of patients experienced an improvement in pain control using concomitant drugs during radiotherapy. Our study underlines the role of radiotherapy in the management of metastatic bone pain. The use of rapid-onset opioids to prevent predictable pain is a crucial step in managing radiotherapy. An interdisciplinary approach is recommended.
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