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01-01-2024 | Radiotherapy | Original Paper

Short-term pain control after palliative radiotherapy for uncomplicated bone metastases: a prospective cohort study

Authors: Sofia Paola Bianchi, Valeria Faccenda, Pietro Pacifico, Gaia Parma, Sara Saufi, Federica Ferrario, Maria Belmonte, Luca Sala, Elena De Ponti, Denis Panizza, Stefano Arcangeli

Published in: Medical Oncology | Issue 1/2024

Abstract

This study aimed at evaluating the efficacy of different radiotherapy (RT) fractionation regimens in managing uncomplicated painful bone metastases (BM) and identifying predictive factors for pain control. Patients with 1 to 4 symptomatic BM from any primary solid tumors and a life expectancy exceeding 3 months were included in the study and received palliative RT, with SBRT restricted in the context of oligometastatic disease or in patients with good prognosis. Pain analysis using the Brief Pain Inventory (BPI) tool was conducted at baseline, 1 and 3 months after RT. Analgesic intake was recorded as morphine-equivalent doses (OME). Pain response was assessed using the International Consensus on Palliative Radiotherapy Endpoint (ICPRE). Multivariate logistic regression analyzed patient-related, tumor-related, and treatment-related factors predicting BM pain control at 3 months post-RT. From Feb 2022 to Feb 2023, 44 patients with 65 symptomatic BM were investigated. Breast (32%) and lung (24%) tumors were the most common primary tumors. Treatment plans included 3DCRT (60%) and VMAT (40%), with a median biological effective dose for tumors (BED) of 29 Gy [14–108]. All patients completed the 3-month follow-up. Pain response rates were 62% at 1 month and 60% at 3 months. Responders had better PS ECOG scores (67%; P = 0.008) and received active systemic therapies (67%: P = 0.036). Non-responders had lower pretreatment BPI (mean: 13.7 vs. 58.2; P = 0.032), with significantly higher values after 1 month (mean: 9.1 vs. 5.3, P = 0.033). Baseline BPI (OR: 1.17; 95% CI: 1.032–1.327; P = 0.014) and BPI at 1 month (OR: 0.83; 95% CI: 0.698–0.976; P = 0.025) were independent predictors of pain response at 3 months. Our findings show that palliative RT ensured short-term pain control in patients with BM, regardless of tumor type and dose-fractionation regimen. A larger sample size and a longer follow-up could potentially identify which patients are likely to benefit most from RT, and which fractionation might be indicated for achieving a durable pain relief. A multidisciplinary approach is paramount to provide a better care to BM patients.

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Title: Short-term pain control after palliative radiotherapy for uncomplicated bone metastases: a prospective cohort study
Authors: Sofia Paola Bianchi
Valeria Faccenda
Pietro Pacifico
Gaia Parma
Sara Saufi
Federica Ferrario
Maria Belmonte
Luca Sala
Elena De Ponti
Denis Panizza
Stefano Arcangeli
Publication date: 01-01-2024
Publisher: Springer US
Keywords: Radiotherapy
Metastasis
Published in: Medical Oncology / Issue 1/2024
Print ISSN: 1357-0560
Electronic ISSN: 1559-131X
DOI: https://doi.org/10.1007/s12032-023-02238-9

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