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Palliative Radiation Therapy for Painful Bone Metastases From Solid Tumors Delivered With Static Ports of Tomotherapy
S694
International Journal of Radiation Oncology Biology Physics
Materials/Methods: We retrospectively reviewed 68 spinal segments in 16 patients, irradiated using conventional RT for pain palliation between 2009 and 2012. Fracture was defined as a newly developed VCF or progression of existing fracture after irradiation. The target volume included all metastatic spinal segments and additional 1 level of non-metastatic vertebras adjacent to tumor involved spines. The evaluation of VCF was based on serial imaging studies including CT or MRI. Results: The median follow up was 7.8 months. In all 68 spinal segments, there were 6 fracture events (8.8%) including 3 new VCFs and 3 fracture progressions. Observed VCF rates in vertebral segments with prior irradiation history or pre-existing compression fracture were 30.0%, and 75.0% compared with those without prior irradiation history or pre-existing compression fracture, 5.2% and 4.7%, respectively (both p < 0.05). The 1-year fracture free probability was 87.8% (95% CI 78.2-97.4). On multivariate analysis, prior irradiation history (HR 7.30, 95% CI 1.3140.86) and pre-existing compression fracture (HR 18.45, 95% CI 3.4299.52) were independent risk factors for VCF. Conclusions: The incidence of VCF following conventional RT to spine was not very high, regardless of involvement of metastatic tumor. Spines which had irradiation and/or compression fracture before RT were high risk of VCF, requiring close observation. Author Disclosure: W. Rhee: None. K. Kim: None. J. Chang: None. M. Kim: None. H. Kim: None. S. Choi: None. W. Koom: None.
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3229 Palliative Radiation Therapy for Painful Bone Metastases From Solid Tumors Delivered With Static Ports of Tomotherapy P. Franco,1 F. Migliaccio,1 P. Torielli,1 C. Arrichiello,1 A. Peruzzo Cornetto,1 V. Casanova Borca,1 D. Cante,1 G. Girelli,1 P. Sciacero,1 M. La Porta,1 S. Tofani,1 and U. Ricardi2; 1AUSL Valle d’Aosta, Aosta, Italy, 2 University of Torino, Turin, Italy Purpose/Objective(s): To evaluate pain response to palliative radiation therapy delivered with static ports of tomotherapy in patients affected with painful bone metastases from solid tumors. Materials/Methods: A total of 130 patients (185 osseous lesions) were treated between 2010 and 2013 with TD. Three fractionation schedules were employed according to clinical decision-making (3 Gy x 10; 4 Gy x 5; 8 Gy x 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 radiation therapy 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 morphineequivalent 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 seconds 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. Conclusions: Static ports of tomotherapy are a valid option to deliver palliative radiation therapy for painful bone metastases from solid tumors. Author Disclosure: P. Franco: H. Speakers Bureau; Accuray. I. Travel Expenses; Accuray. K. Advisory Board; Accuray Breast Advisory Board. F. Migliaccio: None. P. Torielli: None. C. Arrichiello: None. A. Peruzzo Cornetto: None. V. Casanova Borca: None. D. Cante: None. G. Girelli: None. P. Sciacero: None. M. La Porta: None. S. Tofani: None. U. Ricardi: None.
Radiation Therapy for Symptomatic Bone Metastases: The Effect of Calculated Dose and Dose Distribution on Intensity of Pain Relief and Time of Pain Relief H. Kobayashi, F. Ito, Y. Oie, H. Hattori, K. Ito, Y. Saito, and H. Toyama; Fujita Health University, Toyoake, Japan Purpose/Objective(s): External beam radiation therapy is an effective technique in achieving pain control in patients with bone metastases. Pain relief is usually obtained in 70% of patients by using a variety of dose fraction schemes, and the maximum response occurred after the compression of radiation therapy. As palliative therapy will have no influence upon the ultimate course of the disease, the treatment policy should aim at achieving a rapid pain relief as soon as possible. In order to evaluate factors that may influence the beginning of pain relief, we performed a prospective study on patients with bone metastases from various primary sites. Materials/Methods: From January 2003 to December 2013, 5735 patients were under-went radiation therapy in our department of radiation oncology. A total of 827 bone metastases were treated with palliative intent (14.4%). The most common primary site was lung, accounting for 230 (27.8%). Breast, liver, rectal, and prostate tumors accounted for 130 (15.7%), 80 (9.7%), 48 (5.8%), and 35 (4.2%) patients, respectively. The most frequent site of metastases was the spine, followed by the pelvis and limbs. CTVs were determined by the assistance of plain X-p, CT, bone scintigram and FDG-PET. CTVs plus 2 cm margin with all direction were PTVs, those were equal to irradiation fields. Irradiation fields were treated with one main fraction schedule, that is 40 Gy/20 fractions in 4 weeks. Irradiation techniques consisted of single portal, opposed portals, and conformal (IMRT included ). The maximum, mean, and minimum doses in PTV were calculated by inaccle3. Pain intensity was self-assessed by patients using a scale graduated from 0 to 10. Patients were asked for the scale at least once a week from the beginning of radiation therapy till 3 weeks after compression of irradiation. Pain relief meant the achievement of the score 3 down in the scale. Results: The overall degree of response to radiation therapy is 65%. Metastases from lung tumors appeared to be the least responsive (40%). Cumulative number of patients with pain relief as a function of time from the beginning of radiation therapy (response curve; RC) shows a sigmoid curve with rapid increase at 2-3 weeks. The primary sites influence the slopes at 2-3 weeks of RC, whose slopes of breast and prostate are steeper than that of lung. Irradiation techniques do not influence the slopes at 2-3 weeks of RC, but influence the time of initial pain relief. Irradiation technique, which shows the beginning of pain relief in most early, is conformal (IMRT included ). The maximum, mean, and minimum doses in PTV do not influence the slopes at 2-3 weeks of RC, and do not influence the time of initial pain relief. Conclusions: In order to achieve early pain control in patients with bone metastases, conformal (IMRT included) is the best irradiation technique. FDG-PET will become more important in palliative radiation therapy. Author Disclosure: H. Kobayashi: None. F. Ito: None. Y. Oie: None. H. Hattori: None. K. Ito: None. Y. Saito: None. H. Toyama: None.
3231 Painful Diseases Other Than Bone Metastasis Are More Frequently Treated With Radiation Therapy Than Bone Metastasis T. Saito, T. Toyofuku, R. Toya, A. Semba, Y. Fukugawa, T. Matsuyama, and N. Oya; Kumamoto University Hospital, Kumamoto, Japan Purpose/Objective(s): Radiation therapy plays an important role in treating cancer pain and much is known regarding the response rate, pain relief duration, dose fractionation, and effectiveness of retreatment in patients with painful bone metastasis. Therefore it is a standard part of the management of these patients. On the other hand, the pain-palliating effect of radiation therapy in other painful diseases has not been well studied. This raises the question whether enough other painful tumor lesions are treated by radiation therapy to warrant investigation into its effect in those
International Journal of Radiation Oncology Biology Physics
Materials/Methods: We retrospectively reviewed 68 spinal segments in 16 patients, irradiated using conventional RT for pain palliation between 2009 and 2012. Fracture was defined as a newly developed VCF or progression of existing fracture after irradiation. The target volume included all metastatic spinal segments and additional 1 level of non-metastatic vertebras adjacent to tumor involved spines. The evaluation of VCF was based on serial imaging studies including CT or MRI. Results: The median follow up was 7.8 months. In all 68 spinal segments, there were 6 fracture events (8.8%) including 3 new VCFs and 3 fracture progressions. Observed VCF rates in vertebral segments with prior irradiation history or pre-existing compression fracture were 30.0%, and 75.0% compared with those without prior irradiation history or pre-existing compression fracture, 5.2% and 4.7%, respectively (both p < 0.05). The 1-year fracture free probability was 87.8% (95% CI 78.2-97.4). On multivariate analysis, prior irradiation history (HR 7.30, 95% CI 1.3140.86) and pre-existing compression fracture (HR 18.45, 95% CI 3.4299.52) were independent risk factors for VCF. Conclusions: The incidence of VCF following conventional RT to spine was not very high, regardless of involvement of metastatic tumor. Spines which had irradiation and/or compression fracture before RT were high risk of VCF, requiring close observation. Author Disclosure: W. Rhee: None. K. Kim: None. J. Chang: None. M. Kim: None. H. Kim: None. S. Choi: None. W. Koom: None.
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3229 Palliative Radiation Therapy for Painful Bone Metastases From Solid Tumors Delivered With Static Ports of Tomotherapy P. Franco,1 F. Migliaccio,1 P. Torielli,1 C. Arrichiello,1 A. Peruzzo Cornetto,1 V. Casanova Borca,1 D. Cante,1 G. Girelli,1 P. Sciacero,1 M. La Porta,1 S. Tofani,1 and U. Ricardi2; 1AUSL Valle d’Aosta, Aosta, Italy, 2 University of Torino, Turin, Italy Purpose/Objective(s): To evaluate pain response to palliative radiation therapy delivered with static ports of tomotherapy in patients affected with painful bone metastases from solid tumors. Materials/Methods: A total of 130 patients (185 osseous lesions) were treated between 2010 and 2013 with TD. Three fractionation schedules were employed according to clinical decision-making (3 Gy x 10; 4 Gy x 5; 8 Gy x 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 radiation therapy 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 morphineequivalent 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 seconds 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. Conclusions: Static ports of tomotherapy are a valid option to deliver palliative radiation therapy for painful bone metastases from solid tumors. Author Disclosure: P. Franco: H. Speakers Bureau; Accuray. I. Travel Expenses; Accuray. K. Advisory Board; Accuray Breast Advisory Board. F. Migliaccio: None. P. Torielli: None. C. Arrichiello: None. A. Peruzzo Cornetto: None. V. Casanova Borca: None. D. Cante: None. G. Girelli: None. P. Sciacero: None. M. La Porta: None. S. Tofani: None. U. Ricardi: None.
Radiation Therapy for Symptomatic Bone Metastases: The Effect of Calculated Dose and Dose Distribution on Intensity of Pain Relief and Time of Pain Relief H. Kobayashi, F. Ito, Y. Oie, H. Hattori, K. Ito, Y. Saito, and H. Toyama; Fujita Health University, Toyoake, Japan Purpose/Objective(s): External beam radiation therapy is an effective technique in achieving pain control in patients with bone metastases. Pain relief is usually obtained in 70% of patients by using a variety of dose fraction schemes, and the maximum response occurred after the compression of radiation therapy. As palliative therapy will have no influence upon the ultimate course of the disease, the treatment policy should aim at achieving a rapid pain relief as soon as possible. In order to evaluate factors that may influence the beginning of pain relief, we performed a prospective study on patients with bone metastases from various primary sites. Materials/Methods: From January 2003 to December 2013, 5735 patients were under-went radiation therapy in our department of radiation oncology. A total of 827 bone metastases were treated with palliative intent (14.4%). The most common primary site was lung, accounting for 230 (27.8%). Breast, liver, rectal, and prostate tumors accounted for 130 (15.7%), 80 (9.7%), 48 (5.8%), and 35 (4.2%) patients, respectively. The most frequent site of metastases was the spine, followed by the pelvis and limbs. CTVs were determined by the assistance of plain X-p, CT, bone scintigram and FDG-PET. CTVs plus 2 cm margin with all direction were PTVs, those were equal to irradiation fields. Irradiation fields were treated with one main fraction schedule, that is 40 Gy/20 fractions in 4 weeks. Irradiation techniques consisted of single portal, opposed portals, and conformal (IMRT included ). The maximum, mean, and minimum doses in PTV were calculated by inaccle3. Pain intensity was self-assessed by patients using a scale graduated from 0 to 10. Patients were asked for the scale at least once a week from the beginning of radiation therapy till 3 weeks after compression of irradiation. Pain relief meant the achievement of the score 3 down in the scale. Results: The overall degree of response to radiation therapy is 65%. Metastases from lung tumors appeared to be the least responsive (40%). Cumulative number of patients with pain relief as a function of time from the beginning of radiation therapy (response curve; RC) shows a sigmoid curve with rapid increase at 2-3 weeks. The primary sites influence the slopes at 2-3 weeks of RC, whose slopes of breast and prostate are steeper than that of lung. Irradiation techniques do not influence the slopes at 2-3 weeks of RC, but influence the time of initial pain relief. Irradiation technique, which shows the beginning of pain relief in most early, is conformal (IMRT included ). The maximum, mean, and minimum doses in PTV do not influence the slopes at 2-3 weeks of RC, and do not influence the time of initial pain relief. Conclusions: In order to achieve early pain control in patients with bone metastases, conformal (IMRT included) is the best irradiation technique. FDG-PET will become more important in palliative radiation therapy. Author Disclosure: H. Kobayashi: None. F. Ito: None. Y. Oie: None. H. Hattori: None. K. Ito: None. Y. Saito: None. H. Toyama: None.
3231 Painful Diseases Other Than Bone Metastasis Are More Frequently Treated With Radiation Therapy Than Bone Metastasis T. Saito, T. Toyofuku, R. Toya, A. Semba, Y. Fukugawa, T. Matsuyama, and N. Oya; Kumamoto University Hospital, Kumamoto, Japan Purpose/Objective(s): Radiation therapy plays an important role in treating cancer pain and much is known regarding the response rate, pain relief duration, dose fractionation, and effectiveness of retreatment in patients with painful bone metastasis. Therefore it is a standard part of the management of these patients. On the other hand, the pain-palliating effect of radiation therapy in other painful diseases has not been well studied. This raises the question whether enough other painful tumor lesions are treated by radiation therapy to warrant investigation into its effect in those