International Bone Metastases Consensus Research Articles

Efficacy and tolerability of single-fraction radiotherapy for spinal bone metastases in a low-middle-income country setting: a prospective study

AimsThis study aimed to evaluate the symptomatic efficacy and tolerability of three different radiotherapy (RT) regimens for patients with vertebral metastases in a low-middle-income country setting, focusing specifically on the effectiveness of single-fraction radiotherapy.MethodsConducted at the National Institute of Cancer Research and Hospital, Bangladesh, from July 1, 2020, to June 30, 2021, this prospective, non-randomized study enrolled 90 patients aged 18 to 75 years with histologically confirmed primary malignancies and vertebral metastases. Patients were allocated to one of three treatment arms: 8 Gy in a single fraction (Arm A), 20 Gy in 5 fractions (Arm B), or 30 Gy in 10 fractions (Arm C). The primary endpoint was pain response at 12 weeks, assessed by the Visual Analogue Scale and International Bone Metastases Consensus. Secondary endpoints included toxicity, measured by the Common Terminology Criteria for Adverse Events, and overall survival.ResultsPain control at 12 weeks showed no significant differences among the treatment groups, with 70% of patients in Arm A, 67% in Arm B, and 70% in Arm C experiencing either partial or complete pain relief (p = 0.95). The overall survival rates were comparable across the groups (median survival, 7 months for arms A and C, 6 months for Arm B). Skin toxicity was significantly lower in Arm A (10% incidence) compared to arms B (30%) and C (47%) (p = 0.017). There were no reports of Grade 3 or higher toxicities.ConclusionThe study confirms the efficacy and safety of single-fraction RT for spinal bone metastases, providing significant pain relief and lower skin toxicity relative to multiple fraction regimens. These results confirm the efficacy of single-fraction RT in the treatment of vertebral metastases also in resource-limited settings, suggesting its broader adoption to reduce toxicity and treatment burdens in low-middle-income countries.

Palliative Radiotherapy for Painful Bone Metastases from Solid Tumors Delivered with Static Ports of Tomotherapy (TomoDirect): Feasibility and Clinical Results

Purpose: To evaluate the feasibility and response to palliative radiotherapy delivered with static ports of tomotherapy—TomoDirect (TD) in patients affected with painful bone metastases from solid tumors. Methods: A prospective cohort of 130 patients (185 osseous lesions) was treated between 2010 and 2013 with TD. Three fractionation schedules were employed according to clinical decision-making (3 Gy × 10; 4 Gy × 5; 8 Gy × 1). Pain response was investigated at 2 weeks and 2 months (for evaluable patients). The Numeric Rating Scale (NRS-11) was used to assess pain. Response rates to radiotherapy were calculated following the criteria of the International Bone Metastases Consensus Group (IBMCG), accounting for the use of concomitant analgesics (response: complete or partial; non-response: stable pain, pain progression or “other”). Analgesic consumption was recalculated into the daily oral morphine-equivalent dose (OMED). Results: Most of the patients had 1–2 bone metastases (91); those with multiple lesions mostly had a metachronous presentation (60%). Synchronous lesions were mainly approached with multiple plans (63%). Most treatments employed 3–4 fields (77%). Treatment times ranged from 255 to 939 s depending on fractionation, fields, and target lesions number. At 2 weeks, the median self-reported worst pain decreased significantly as median oral morphine-equivalent dose regardless of fractionation used. The response rate according to the IBMCG-based response categories ranged from 45 to 55%. Pain relief duration seems (response at 2 months) slightly inferior with the single fraction approach, with a higher re-treatment rate. At 2 weeks, the median self-reported worst pain and OMED significantly decreased regardless of fractionation (response rate: 49–55%). Pain relief decreased at 2 months, especially for single fraction (higher re-treatment rate). Conclusion: TD is a valid option to deliver palliative radiotherapy for painful bone metastases from solid tumors.

Stereotactic Body Radiotherapy with Helical Tomotherapy for Pain Palliation in Spine Metastasis

To evaluate the pain response, local tumor control and toxicity of stereotactic body radiotherapy (SBRT) with helical tomotherapy (HT) in the patients with spine metastasis. From May 2009 to June 2010, 22 patients with 31 lesions were treated by SBRT. Dose scheme were 24 Gy in 3 fractions (87.1%), 30 Gy in 5 fractions (9.7%), and 16 Gy in a single fraction (3.2%). Pain was assessed using a numerical rating scale. Analgesic consumption was recalculated into the daily oral morphine-equivalent dose (OMED). The response criteria of International Bone Metastases Consensus Group (IBMCG) was used. The median follow-up duration was 10 months (range 3-23 months). After SBRT the mean pain score decreased significantly (4.32 before SBRT, 0.71 at 3 months). However, median OMED didn't decrease until 3 months after SBRT (Median OMED; 34.5 mg before SBRT, 45 mg at 3 months). Pain response rate and pain progression-free survival rate at 3 month was 96.8 and 93.5%, respectively. Local progression-free survival rate at 3 month was 93.5%. There was no severe acute toxicity. SBRT with HT is a safe and effective treatment modality for local tumor control and pain palliation associated with spine metastasis.

Functional Interference due to Pain Following Palliative Radiotherapy for Bone Metastases Among Patients in Their Last Three Months of Life.

BackgroundTo compare the self-reported ratings of functional interference caused by pain between patients who did and did not respond to palliative radiotherapy for bone metastases during their last three months of life.MethodsA prospectively gathered Brief Pain Inventory (BPI) database compiled from patients receiving palliative radiotherapy for painful bone metastases was reviewed. Demographic and clinical data, pain response rates and self-reported ratings of functional interference caused by pain were analyzed for those patients who died within three months of beginning radiotherapy.ResultsFrom 400 patients in the database, 83 died within 3 months of beginning radiotherapy. There were 54 male and 29 female patients. Their median age was 69 years and their median KPS was 70. The three most common primary cancers were lung (40%), gastrointestinal (16%) and breast (14%). For patients with available follow-up information the 1-month overall pain response rate was 78% and the 2-month rate was 83%, which include both complete and partial responses as defined by the International Bone Metastases Consensus. At 1 month, patients responding to treatment reported significantly less interference by pain on their general activity, walking ability, normal work, sleeping, and enjoyment of life than did patients not responding to treatment.ConclusionsPatients that responded to treatment reported less functional interference due to pain than did patients who did not respond. Despite being very near the end of life, patients responding to palliative radiotherapy for painful bone metastases may benefit from more than pain relief alone.

Effectiveness of Palliative Radiotherapy in the Treatment of Bone Metastases Employing the Brief Pain Inventory

ABSTRACTBackground: Many randomized trials in the treatment of bone metastases have reported that radiotherapy reduces bone pain and decreases analgesic consumption. However, reporting of other pain-related functional outcomes has been sparse. The primary objective of this study was to prospectively determine changes in pain intensity and its functional interference following palliative radiotherapy for painful bone metastases.Materials and Methods: Patients with symptomatic bone metastases treated with palliative radiotherapy from May 2003 to June 2005 were followed with the Brief Pain Inventory (BPI) at baseline, 1, 2, and 3 months after the delivery of radiotherapy. Radiotherapy outcome was assessed using the International Bone Metastases Consensus response definitions.Results: One hundred and ninety-nine patients were treated with palliative radiotherapy. All three pain scores and seven functional interference items at two months showed a significant improvement compared to the baseline. Complete, par...

International Bone Metastases Consensus on Endpoint Measurements for Future Clinical Trials: Proceedings of the First Survey and Meeting (Work in Progress) International Bone Metastases Consensus Working Party

International Bone Metastases Consensus on Endpoint Measurements for Future Clinical Trials: Proceedings of the First Survey and Meeting (Work in Progress) International Bone Metastases Consensus Working Party