Top

Published in:

01-10-2015 | Original Article

Prophylactic dexamethasone effectively reduces the incidence of pain flare following spine stereotactic body radiotherapy (SBRT): a prospective observational study

Authors: Luluel Khan, Andrew Chiang, Liying Zhang, Isabelle Thibault, Gillian Bedard, Erin Wong, Andrew Loblaw, Hany Soliman, Michael G. Fehlings, Edward Chow, Arjun Sahgal

Published in: Supportive Care in Cancer | Issue 10/2015

Abstract

Purpose

The purpose of this study was to determine the incidence of pain flare (PF) in patients receiving spine stereotactic body radiotherapy (SBRT) treated with prophylactic oral dexamethasone (DEX) 1 h before and for 4 days following SBRT.

Methods

Forty-seven patients were accrued on this prospective observational study. The first cohort of 24 patients was treated with 4 mg, while a second cohort of 23 patients treated with 8 mg of DEX. The Brief Pain Inventory (BPI) was used to score pain and functional interference each day during SBRT and for 10 days following. Comparisons between the 4 and 8 mg cohorts, in addition to our previously reported steroid naïve patients post SBRT (n = 41), were also performed.

Results

The total incidence of PF was 19 % (9/47). The incidence in the 4 and 8 mg cohorts was 25 % (6/24) and 13 % (3/23), respectively, and the difference was not statistically significant (p = 0.46). Comparing functional interference, the 4 mg cohort had better profile in walking ability (p < 0.005) and relationships with others (p < 0.035) compared to the 8 mg cohort. Compared to our previously reported steroid naïve cohort, prophylactic DEX significantly reduced the incidence of PF (68 vs. 19 %, p < 0.0001, respectively), patients had lower worst pain scores, and improved general activity interference outcome.

Conclusion

We recommend prophylactic DEX for patients treated with spine SBRT. Our current practice is based on the 4 mg protocol primarily due to the improved functional interference outcomes. A randomized trial is required to finalize the optimal regimen and schedule.

Sahgal A, Bilsky M, Chang EL et al (2011) Stereotactic body radiotherapy for spinal metastases: Current status, with a focus on its application in the postoperative patient. J Neurosurg Spine 14(2):151–66. doi:10.3171/2010.9.SPINE091005 CrossRefPubMed

Sahgal A, Chou D, Ames C et al (2007) Image-guided robotic stereotactic body radiotherapy for benign spinal tumors: the university of california san francisco preliminary experience. Technol Cancer Res Treat 6(6):595–604CrossRefPubMed

Sahgal A, Larson DA, Chang EL (2008) Stereotactic body radiosurgery for spinal metastases: a critical review. Int J Radiat Oncol Biol Phys 71(3):652–65. doi:10.1016/j.ijrobp.2008.02.060 CrossRefPubMed

Sahgal A, Roberge D, Schellenberg D et al (2012) The Canadian association of radiation oncology scope of practice guidelines for lung, liver and spine stereotactic body radiotherapy. Clin Oncol (R Coll Radiol) 24(9):629–39. doi:10.1016/j.clon.2012.04.006 CrossRef

Lo SS, Sahgal A, Chang EL et al (2013) Serious complications associated with stereotactic ablative radiotherapy and strategies to mitigate the risk. Clin Oncol (R Coll Radiol) 25(6):378–87. doi:10.1016/j.clon.2013.01.003 CrossRef

Sahgal A, Weinberg V, Ma L et al (2013) Probabilities of radiation myelopathy specific to stereotactic body radiation therapy to guide safe practice. Int J Radiat Oncol Biol Phys 85(2):341–7. doi:10.1016/j.ijrobp.2012.05.007 CrossRefPubMed

Sahgal A, Ma L, Weinberg V et al (2012) Reirradiation human spinal cord tolerance for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 82(1):107–16. doi:10.1016/j.ijrobp.2010.08.021 CrossRefPubMed

Sahgal A, Ma L, Gibbs I et al (2010) Spinal cord tolerance for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 77(2):548–53. doi:10.1016/j.ijrobp.2009.05.023 CrossRefPubMed

Sahgal A, Atenafu EG, Chao S et al (2013) Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score. J Clin Oncol 31(27):3426–31. doi:10.1200/JCO.2013.50.1411 CrossRefPubMed

10.

Cunha MV, Al-Omair A, Atenafu EG et al (2012) Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): Analysis of predictive factors. Int J Radiat Oncol Biol Phys 84(3):e343–9. doi:10.1016/j.ijrobp.2012.04.034 CrossRefPubMed

11.

Chiang A, Zeng L, Zhang L et al (2013) Pain flare is a common adverse event in steroid-naive patients after spine stereotactic body radiation therapy: a prospective clinical trial. Int J Radiat Oncol Biol Phys 86(4):638–42CrossRefPubMed

12.

Cleeland CS, Ryan KM (1994) Pain assessment: Global use of the brief pain inventory. Ann Acad Med Singap 23(2):129–38PubMed

13.

Hird A, Wong R, Flynn C et al (2009) Impact of pain flare on patients treated with palliative radiotherapy for symptomatic bone metastases. J Pain Manag 4(2):401–6

14.

Chow E, Loblaw A, Harris K (2007) Dexamethasone for the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a pilot study. Support Care Cancer 15(6):643–7CrossRefPubMed

15.

Wang XS, Rhines LD, Shiu AS et al (2012) Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1–2 trial. Lancet Oncol 13(4):395–402. doi:10.1016/S1470-2045(11)70384-9 PubMedCentralCrossRefPubMed

16.

Walker PW, Palla S, Pei BL et al (2008) Switching from methadone to a different opioid: what is the equianalgesic dose ratio? J Palliat Med 11(8):1103–8. doi:10.1089/jpm.2007.0285 PubMedCentralCrossRefPubMed

17.

Hird A, Zhang L, Holt T et al (2009) Dexamethasone for the prophylaxis of radiation-induced pain flare after palliative radiotherapy for symptomatic bone metastases: a phase II study. Clin Oncol (R Coll Radiol) 21(4):329–35. doi:10.1016/j.clon.2008.12.010 CrossRef

18.

Pan HY, Allen PK, Wang XS et al (2014) Incidence and predictive factors of pain flare after spine stereotactic body radiation therapy: Secondary analysis of phase 1/2 trials. Int J Radiat Oncol Biol Phys. doi:10.1016/j.ijrobp.2014.07.037

Title: Prophylactic dexamethasone effectively reduces the incidence of pain flare following spine stereotactic body radiotherapy (SBRT): a prospective observational study
Authors: Luluel Khan
Andrew Chiang
Liying Zhang
Isabelle Thibault
Gillian Bedard
Erin Wong
Andrew Loblaw
Hany Soliman
Michael G. Fehlings
Edward Chow
Arjun Sahgal
Publication date: 01-10-2015
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 10/2015
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-015-2659-z

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2015

Letter to the editor

Cancer rehabilitation: a barometer for survival?

Exercise and dietary advice intervention for survivors of triple-negative breast cancer: effects on body fat, physical function, quality of life, and adipokine profile

Dose response of pegfilgrastim in Japanese breast cancer patients receiving six cycles of docetaxel, doxorubicin, and cyclophosphamide therapy: a randomized controlled trial

Needs of caregivers of cancer patients: validation of the Mexican version of the Support Person Unmet Needs Survey (SPUNS–SFM)

Hyponatremia is a predictor of hospital length and cost of stay and outcome in cancer patients

Keynote webinar | Spotlight on antibody–drug conjugates in cancer