Retrospective analysis of the effectiveness of volumetric modulated arc therapy half‑body irradiation in palliation of pain in patients with multiple bone metastases

Kluska,Adam; Tomasik,Bartłomiej; Osadnik,Arkadiusz; Tracz,Natalia; Trąbska-Kluch,Berenika; Matysiak,Paweł; Łuniewska-Bury,Jolanta; Fijuth,Jacek; Gottwald,Leszek

doi:10.3892/mco.2022.2586

Retrospective analysis of the effectiveness of volumetric modulated arc therapy half‑body irradiation in palliation of pain in patients with multiple bone metastases

Authors:
- Adam Kluska
- Bartłomiej Tomasik
- Arkadiusz Osadnik
- Natalia Tracz
- Berenika Trąbska-Kluch
- Paweł Matysiak
- Jolanta Łuniewska-Bury
- Jacek Fijuth
- Leszek Gottwald
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Affiliations: Department of Radiotherapy, Medical University of Lodz, 93‑509 Łódź, Poland, Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92‑215 Łódź, Poland, Department of Teleradiotherapy, Regional Cancer Center, Copernicus Memorial Hospital of Lodz, 93‑509 Łódź, Poland, Department of Brachytherapy, Regional Cancer Center, Copernicus Memorial Hospital of Lodz, 93‑509 Łódź, Poland
Published online on: September 21, 2022 https://doi.org/10.3892/mco.2022.2586
Article Number: 153

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Abstract

Bone metastases are the most common cause of cancer‑related pain. It has been reported that radiotherapy is efficient in the palliation of pain caused by bone metastases. Half‑body irradiation (HBI) is a method of palliative treatment in patients with multiple metastases to bones. The present study aimed to evaluate the efficiency of upper and lower HBI in reducing pain in patients with multiple bone metastases treated with volumetric modulated arc therapy (VMAT) HBI. A total of 22 patients received HBI based on the VMAT technique between July 2018 and July 2020. Treatment plans were subject to a dosimetric analysis. The absorbed doses ranged from 6 to 8 Gy in a single fraction. The patients rated pain on the 11‑point (0‑10) verbal numeric pain score (VNPS) before irradiation and after 1 month of follow‑up. To assess the analgesic effect of HBI radiotherapy, data from 19 patients who attended the follow‑up visit were analyzed. Before the treatment, the median VNPS of pain was 5 (IQR, 3‑8); after the follow‑up period, it was 3 (IQR, 1‑4) (P=0.003). The median VNPS of the maximum pain within the last month before treatment was 8 (IQR, 7‑10) and after irradiation it was 5 (IQR, 4‑7) (P<0.001). The median VNPS of the average pain within the last month before the treatment was 5 (IQR, 4‑7); after the treatment, it was 3 (IQR, 2‑5) (P=0.003). In conclusion, conformal VMAT‑intensity‑modulated radiation therapy HBI is an effective method for reducing pain in patients with painful multiple bone metastases. Conformal techniques of radiation allow for the reduction of doses to organs at risk thus potentially reducing the toxicity of treatment.

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1	Mercadante S: Malignant bone pain: Pathophysiology and treatment. Pain. 69:1–18. 1997.PubMed/NCBI View Article : Google Scholar
2	Tubiana-Hulin M: Incidence, prevalence and distribution of bone metastases. Bone. 12 (Suppl 1):S9–S10. 1991.PubMed/NCBI View Article : Google Scholar
3	Foley KM: The treatment of cancer pain. N Engl J Med. 313:84–95. 1985.PubMed/NCBI View Article : Google Scholar
4	Lin A and Ray ME: Targeted and systemic radiotherapy in the treatment of bone metastasis. Cancer Metastasis Rev. 25:669–675. 2006.PubMed/NCBI View Article : Google Scholar
5	De Felice F, Piccioli A, Musio D and Tombolini V: The role of radiation therapy in bone metastases management. Oncotarget. 8:25691–25699. 2017.PubMed/NCBI View Article : Google Scholar
6	Wu JS, Wong RK, Lloyd NS, Johnston M, Bezjak A and Whelan T: Supportive Care Guidelines Group of Cancer Care Ontario. Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases-an evidence-based practice guideline. BMC Cancer. 4(71)2004.PubMed/NCBI View Article : Google Scholar
7	Niibe Y and Hayakawa K: Oligometastases and oligo-recurrence: The new era of cancer therapy. Jpn J Clin Oncol. 40:107–111. 2010.PubMed/NCBI View Article : Google Scholar
8	Furlan C, Trovo M, Drigo A, Capra E and Trovo MG: Half-body irradiation with tomotherapy for pain palliation in metastatic breast cancer. J Pain Symptom Manage. 47:174–180. 2014.PubMed/NCBI View Article : Google Scholar
9	Berg RS, Yilmaz MK, Høyer M, Keldsen N, Nielsen OS and Ewertz M: Half body irradiation of patients with multiple bone metastases: A phase II trial. Acta Oncol. 48:556–561. 2009.PubMed/NCBI View Article : Google Scholar
10	Pal S, Dutta S, Adhikary SS, Bhattacharya B, Ghosh B and Patra NB: Hemi body irradiation: An economical way of palliation of pain in bone metastasis in advanced cancer. South Asian J Cancer. 3:28–32. 2014.PubMed/NCBI View Article : Google Scholar
11	Salazar OM, Rubin P, Hendrickson FR, Poulter C, Zagars G, Feldman MI, Asbell S and Doss L: Single-dose half-body irradiation for the palliation of multiple bone metastases from solid tumors: A preliminary report. Int J Radiat Oncol Biol Phys. 7:773–781. 1981.PubMed/NCBI View Article : Google Scholar
12	Salazar OM, Rubin P, Hendrickson FR, Komaki R, Poulter C, Newall J, Asbell SO, Mohiuddin M and Van Ess J: Single-dose half-body irradiation for palliation of multiple bone metastases from solid tumors. Final Radiation Therapy Oncology Group report. Cancer. 58:29–36. 1986.PubMed/NCBI View Article : Google Scholar
13	Salazar OM, Sandhu T, da Motta NW, Escutia MA, Lanzós-Gonzales E, Mouelle-Sone A, Moscol A, Zaharia M and Zaman S: Fractionated half-body irradiation (HBI) for the rapid palliation of widespread, symptomatic, metastatic bone disease: A randomized Phase III trial of the International Atomic Energy Agency (IAEA). Int J Radiat Oncol Biol Phys. 50:765–775. 2001.PubMed/NCBI View Article : Google Scholar
14	Fowler JF and Travis EL: The radiation pneumonitis syndrome in half-body radiation therapy. Int J Radiat Oncol Biol Phys. 4:1111–1113. 1978.PubMed/NCBI View Article : Google Scholar
15	Poulter CA, Cosmatos D, Rubin P, Urtasun R, Cooper JS, Kuske RR, Hornback N, Coughlin C, Weigensberg I and Rotman M: A report of RTOG 8206: A phase III study of whether the addition of single dose hemibody irradiation to standard fractionated local field irradiation is more effective than local field irradiation alone in the treatment of symptomatic osseous metastases. Int J Radiat Oncol Biol Phys. 23:207–214. 1992.PubMed/NCBI View Article : Google Scholar
16	Macchia G, Ferro M, Cilla S, Buwenge M, Ianiro A, Boccardi M, Picardi V, Ferro M, Arena E, Zamagni A, et al: Efficacy and safety of 3D-conformal half body irradiation in patients with multiple bone metastases. Clin Exp Metastasis. 35:747–752. 2018.PubMed/NCBI View Article : Google Scholar
17	Tamaki T, Hirai R, Igari M, Kumazaki Y, Noda SE, Suzuki Y and Kato S: Dosimetric comparison of three-dimensional conformal radiotherapy versus volumetric-arc radiotherapy in cervical cancer treatment: Applying the central-shielding principle to modern technology. J Radiat Res. 59:639–648. 2018.PubMed/NCBI View Article : Google Scholar
18	Sudha SP, Seenisamy R and Bharadhwaj K: Comparison of dosimetric parameters of volumetric modulated arc therapy and three-dimensional conformal radiotherapy in postmastectomy patients with carcinoma breast. J Cancer Res Ther. 14:1005–1009. 2018.PubMed/NCBI View Article : Google Scholar