Publications (2)10.17 Total impact
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Article: Single fraction conventional external beam radiation therapy for bone metastases: A systematic review of randomised controlled trials.
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ABSTRACT: PURPOSE: To determine the optimal dose of single fraction conventional palliative radiation therapy for the relief of pain caused by bone metastases. MATERIAL AND METHODS: Ovid version of EMBASE and EMBASE Classic, MEDLINE, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched for relevant randomised controlled trials. Pain response data were standardised according to the clinical trial endpoints recommended by the International Bone Metastases Consensus Working Party. RESULTS: From 2696 references we selected 26 articles for review. These described 24 trials that cumulatively randomised 3233 patients to 28 single fraction arms: two arms received 4Gy, one 5Gy, one 6Gy, twenty-two 8Gy, one 10Gy and one 8-15Gy. Eighty-four percent of all patients received 8Gy and this imbalance precluded formal modelling analyses for different doses. Efficacy endpoints and pain assessment times varied. In general, higher doses produced better pain response rates. The overall (OR) and complete (CR) pain response rates for different doses according to available intention-to-treat (ITT) and assessable patient (A) figures were: 4Gy [OR(ITT)=23-47%, OR(A)=44-47%, CR(ITT)=15-18%, CR(A)=15-26%], 5Gy [OR(A)=72%, CR(A)=55%], 6Gy [OR(ITT&A)=65%, CR(ITT&A)=21%], 8Gy [OR(ITT)=21-81%, OR(A)=31-93%, CR(ITT)=9-52%, CR(A)=14-57%], 10Gy [OR(A)=84%, CR(A)=39%]. In trials that directly compared different single fraction doses, 8Gy was statistically superior to 4Gy. CONCLUSIONS: 8Gy was by far the most commonly administered single fraction dose within 24 randomised trials of conventional radiation therapy for the palliation of bone metastases. 8Gy should be the standard dose against which future treatments are compared due to its reproducible pain response rate and its established safe profile. The optimal dose for the relief of pain remains an open question, however, 8Gy produced statistically superior pain response rates compared to 4Gy in trials directly comparing those doses, and in general across all trials doses of 8Gy or more produced numerically superior pain response rates compared to doses less than 8Gy.Radiotherapy and Oncology 01/2013; · 5.58 Impact Factor -
Article: Would larger radiation fields lead to a faster onset of pain relief in the palliation of bone metastases?
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ABSTRACT: Hemibody irradiation has been shown to relieve bony metastatic pain within 24-48 hours of treatment, whereas for local external beam radiation, onset of pain relief is 1-4 weeks after radiation. The primary objective of this study is to examine whether there is a relationship between the areas of radiation treatment and onset of pain relief. From Jan 1999 to Jan 2002, a total of 653 patients with symptomatic bone metastases were treated with external beam radiation. Pain scores and analgesic consumption were recorded at baseline and Weeks 1, 2, 4, 8, and 12. The areas of radiation treatment for all patients were calculated, then correlated with the response and analyzed in various ways. We first compared pain score alone with mean radiation field size. Second, we combined pain score and analgesic consumption. Last, we implemented the International Consensus end points for pain score and analgesic intake. Assessment of 653 patients showed no significant correlation comparing pain scores alone with radiation field area, with the exception of Week 4 for partial responders. Again, no significant correlation was found when combining both analgesic intake and pain score against radiation field size. Even when implementing the International Consensus end point definitions for radiation response, the only significant correlation between radiation field size and response was observed in Week 2 for partial response. There was no statistical significance between mean areas of radiation treatment with the onset of pain relief.International journal of radiation oncology, biology, physics 02/2009; 74(5):1563-6. · 4.59 Impact Factor
