Re-irradiation of painful bone metastases

1
Re-irradiation of painful bone metastases

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

2
Aim

• 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.

3
Patients and Methods

• 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

4
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

5
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)

6
Results

• Pain relief after re-irradiation in 76 of
  patients
• No change in 24 of patients

7
Results

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

total dose p0,228
interval p0,557
age p0,441
region p0,998
single dose p0,668
8
Side effects of re-irradiation

• Acute 36 (13/36 patients)
• Skin 17 (6/36 patients), CTC I/II
• GI 14 (5/36 patients), CTC I/II
• Fatigue symptoms 14 (5/36 patients)
• Late One soft tissue fibrosis

9
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