Re-irradiation of painful bone metastases

Warszawski A., Baumgartner M., Baumann R., Bremer M., Karstens J.H.,Clinic of Radiotherapy and Special Oncology

Evaluation of a second course of radiotherapy (RT) for painful bone metastases with emphasis• of overall response, • duration of pain relief, and • functional state, • acute and late side effects.

Aim:

retrospective Study, 6/2000-5/2006 Re-Irradiation in 36 patients with painful bone metastases Age: 47 to 85 years (median: 63 years)

dose of re-irradiation: Total dose 4 to 39,6 Gy (median 26 Gy), single doses: 1,5 to 4 Gy

Radiation schemas: First RT course: 10x3 Gy, 15x2,5 Gy Re-irradiation: 10x2 Gy; 7x3 Gy

Patients and Methods:

Intervall RT to re-irradiation: 4 months to 8 years (median 9 months)

Histology of primary tumor: Breast cancer 33% Renal cell carcinoma 16% Prostate cancer 8% Lung cancer 8%

Site of bone metastases: Spinal column: 56% Other: 44%

Patients and Methods:

First radiotherapy course: pain reduction in 82%; no pain relief in 18%

Evaluated parameters:

• Total and single dose of re-irradiation• Interval RT and re-irradiation• Effect of first RT course on pain

intensity• Age• Site of re-irradiation (spinal column vs.

other)

Patients and Methods:

Results:

Pain relief after re-irradiation in 76% of patients

No change in 24% of patients 0

10

20

30

40

50

60

70

80

pain reduction no pain reduction

pain reduction

no pain reduction

Results:

Patients with pain relief after first course of radiotherapy had a significant better response after re-irradiation (p= 0,037)

total dose p=0,228

interval p=0,557

age p=0,441

region p=0,998

single dose p=0,668

Acute: 36% (13/36 patients)

Skin: 17% (6/36 patients), CTC I/IIGI: 14% (5/36 patients), CTC I/IIFatigue symptoms: 14% (5/36 patients)

Late: One soft tissue fibrosis

Side effects of re-irradiation:

Conclusions:

– Reirradiation of painful bone metastases is an effective method

– 76 % of the re-irradiated patients had a pain relief

– The appropriate indications and the optimal dose and fractionation scheme should be further explored in a prospective study