A simple and effective daily pain management method for patients receiving radiation therapy for painful bone metastases

Percutaneous Ablation versus Radiotherapy for Pain Related to Bone and Soft Tissue Malignancies: A Multipayor Database Analysis of Outcomes

PURPOSE

To compare key hospitalization outcomes and cost between percutaneous ablation and external beam radiation therapy (EBRT) among patients admitted with acute cancer-related pain.

MATERIALS AND METHODS

The Merative MarketScan Research Database was queried for all cancer-related hospitalizations from 2009 to 2022 for patients who underwent percutaneous palliative ablation or EBRT for painful bone or soft tissue tumors. Hospital length of stay (LOS), 30-day readmission rate, in-hospital mortality, and total hospitalization costs from the payor perspective were compared using multivariable generalized linear models controlling for patient demographics, comorbid conditions, geographic location, and calendar year. Sensitivity analyses were conducted using different model specifications and coarsened exact matching.

RESULTS

Among 19,793 hospitalizations, patients underwent ablation in 185 (0.9%) cases and EBRT in 19,608 (99.1%) cases. Compared with EBRT, ablation was associated with shorter LOS (-2.0 days; 95% CI, -3.9 to -0.03; P = .046), lower risk of in-hospital mortality (-3.4 percentage points [p.p.]; 95% CI, -5.6 to -1.3; P = .002), lower risk of 30-day readmission (-7.4 p.p.; 95% CI, -13.7 to -1.2; P = .019), and no statistically significant difference in total hospitalization costs ($8,379; 95% CI, -1,947 to 18,706; P = .11).

CONCLUSIONS

Less than 1% of patients hospitalized with acute cancer-related pain and treated with tumor-directed therapy (either via radiation oncology or interventional radiology) underwent percutaneous tumor ablation. Compared with EBRT, percutaneous ablation was associated with shorter LOS, lower risk of in-hospital mortality, and lower risk of 30-day readmission.

Feasibility and Clinical Value of CT-Guided 125I Brachytherapy for Pain Palliation in Patients With Breast Cancer and Bone Metastases After External Beam Radiotherapy Failure

Objectives: To evaluate the feasibility and clinical value of CT-guided iodine-125 (¹²⁵I) brachytherapy for pain palliation in patients with breast cancer and bone metastases after external beam radiotherapy failure. Methods: From January 2014 to July 2016, a total of 90 patients, who had received the standard therapies for bone metastases but still suffered moderate-to-severe pain, were retrospectively studied. About 42 patients were treated with both ¹²⁵I brachytherapy and bisphosphonates (Group A), and 48 patients were treated with bisphosphonates alone (Group B). Results: In Group A, 45 ¹²⁵I brachytherapy procedures were performed in 42 patients with 69 bone metastases; the primary success rate of ¹²⁵I seed implantation was 92.9%, without severe complications. Regarding pain progression of the two groups, Group A exhibited significant relief in "worst pain," "least pain," "average pain," and "present pain" 3-day after treatment and could achieve a 12-week-remission for "worst pain," "least pain," "average pain," and "present pain." The morphine-equivalent 24-h analgesic dose at 3 days, 4 weeks, 8 weeks, and 12 weeks was 91 ± 27, 53 ± 13, 31 ± 17, and 34 ± 12 mg for Group A, and 129 ± 21, 61 ± 16, 53 ± 15, and 105 ± 23 mg for Group B. Group A experienced a lower incidence of analgesic-related adverse events and better quality of life than Group B. Conclusion: The CT-guided ¹²⁵I brachytherapy is a feasible and an effective treatment for the palliation of pain caused by bone metastases from breast cancer after external beam radiotherapy failure.

Treatment of osteolytic solitary painful osseous metastases with radiofrequency ablation or cryoablation: A retrospective study by propensity analysis

The present study aimed to measure the improvement in pain relief and quality of life in patients with osteolytic solitary painful bone metastasis treated by cryoablation (CA) or radiofrequency ablation (RFA). Fifty patients with solitary osteolytic painful bone metastases were retrospectively studied and selected by propensity analysis. Twenty-five patients underwent CA and the remaining twenty-five underwent RFA. Pain relief, in terms of complete response (CR), the number of patients requiring analgesia and the changes in self-rated quality of life (QoL) were measured following the two treatments. Thirty-two percent of patients treated by CA experienced a CR at 12 weeks versus 20% of patients treated by RFA. The rate of CR increased significantly with respect to baseline only in the group treated by CA. In both groups there was a significant change in the partial response with respect to baseline (36% in the CA group vs. 44% in the RFA group). The recurrence rate in the CA and RFA groups was 12% and 8%, respectively. The reduction in narcotic medication requirements with respect to baseline was only significant in the group treated by CA. A significant improvement in self-rated QoL was observed in both groups. The present study seems to suggest that CA only significantly improves the rate of CR and decreases the requirement of narcotic medications. Both CA and RFA led to an improvement in the self-rated QoL of patients after the treatments. However, the results of the present study should be considered as preliminary and to serve as a framework around which future trials may be designed.

Treatment of Solitary Painful Osseous Metastases with Radiotherapy, Cryoablation or Combined Therapy: Propensity Matching Analysis in 175 Patients

PURPOSE

aim of this study was to identify outcomes in pain relief and quality of life in patients with a solitary painful osseous metastasis treated by radiotherapy, cryoablation or the combination using a propensity score matching study design.

MATERIALS AND METHODS

175 patients with painful bone metastases were included in the study. Twenty-five of them underwent a radiation course (20 Gy in five daily fractions) 15 days after the cryoablation. These subjects were retrospectively matched by propensity analysis with a group of subjects treated by radiotherapy (125 subjects) and with a group treated byCryoablation (25 subjects). The pain relief in terms of complete response, rate of subjects requiring analgesics after treatments and the changes in self-rated quality of life were measured. Informed consent was obtained from the subject and the study was approved by the local Ethical Committee.

RESULTS

An higher proportion of subjects treated by cryoablation (32%) or cryoablation followed by RT (72%;) experienced a complete response compared with patients treated by radiotherapy alone (11.2%). After Bonferroni correction strategy, the addition of radiotherapy to cryoablation significantly improved the rate of complete response compared with cryoablation alone (p = 0.011) and this paralleled with an improved self-rated quality of life. Seventeen subjects (13.6%) of patients in the radiotherapy group, 9 (36%) in the cryoablation group, and 19 (76)% in the cryoablation- radiotherapy group did not require narcotic medications.

CONCLUSIONS

The addition of radiotherapy to cryoablation favorably impacts on perceived pain, with a favorable toxicity profile. However, our data should be interpreted with caution and could serve as a framework around which to design future trials.

The role of palliative external beam radiation therapy in boney metastases pain management

Bone is the third most common organ affected by neoplastic metastases, and about 70% of patients with breast cancer or prostate cancer that develop metastases will have osseous involvement. As part of a multi-pronged approach to pain management in these patients, external beam radio therapy (EBRT) continues to be a mainstay of treatment for metastatic bone pain. This article reviews the role of radiation therapy in palliative management strategies for patients with bone metastases, including the clinical and cost-effectiveness of single fraction (SFRT) versus multiple fraction (MFRT) EBRT in pain relief. Studies indicate that SFRT is more cost-effective than MFRT, yet both are clinically effective in pain management. Therefore, EBRT use retains an important place among analgesia, bone modifying agents, chemotherapy, and hormone therapy in improving quality of life (QoL) and reducing morbidity from metastatic bone pain.