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Mawatari H, Shinjo T, Morita T, Kohara H, Yomiya K. Revision of Pharmacological Treatment Recommendations for Cancer Pain: Clinical Guidelines from the Japanese Society of Palliative Medicine. J Palliat Med 2022; 25:1095-1114. [PMID: 35363057 DOI: 10.1089/jpm.2021.0438] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Pain is one of the most common symptoms in cancer patients. The Japanese Society for Palliative Medicine (JSPM) first published its clinical guidelines for the management of cancer pain in 2010. Since then, more research on cancer pain management has been reported, and new drugs have become available in Japan. Thus, the JSPM has now revised the clinical guidelines using a validated methodology. Methods: This guideline was developed through a systematic review, discussion, and the Delphi method, following a formal guideline development process. Results: Thirty-five recommendations were created: 19 for the pharmacological management of cancer pain, 6 for the management of opioid-induced adverse effects, and 10 for pharmacological treatment procedures. Due to the lack of evidence that directly addressed our clinical questions, most of the recommendations had to be based on consensus among committee members and other guidelines. Discussion: It is critical to continue to build high-quality evidence in cancer pain management, and revise these guidelines accordingly.
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Affiliation(s)
- Hironori Mawatari
- Department of Palliative and Supportive Care, Yokohama Minami Kyosai Hospital, Yokohama City, Japan
| | - Takuya Shinjo
- Department of Palliative Medicine, Shinjo Clinic, Kobe City, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu City, Japan
| | - Hiroyuki Kohara
- Department of Palliative Medicine, Hiroshima Prefectural Hospital, Hiroshima City, Japan
| | - Kinomi Yomiya
- Department of Palliative Care, Saitama Cancer Center, Ina-machi, Japan
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Viani GA, Pavoni JF, De Fendi LI. Prophylactic corticosteroid to prevent pain flare in bone metastases treated by radiotherapy. ACTA ACUST UNITED AC 2021; 26:218-225. [PMID: 34211772 DOI: 10.5603/rpor.a2021.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
Background The aim of this study was to evaluate the effectiveness of prophylactic corticosteroids to prevent pain flare (PF) in bone metastases treated with radiotherapy performing a meta-analysis of randomized clinical trials (RCT). Materials and methods RCTs were identified on Medline, Embase, the Cochrane Library, and the proceedings of annual meetings through June 2020. We followed the PRISMA and MOOSE guidelines. A meta-analysis was performed to assess if corticosteroids reduce the PF, pain progression, and the mean of days with PF compared with the placebo. A p-value < 0.05 was considered significant. Results Three RCTs with a total of 713 patients treated were included. The corticosteroids reduced the occurrence of early PF 20.5% (51/248) versus 32% (80/250) placebo, OR = 0.55 (95% CI: 0.36-0.82, p = 0.002). The mean days of PF were reduced to 1.6 days (95% CI: 1.3-1.9, p = 0.0001). Prophylactic corticosteroids had more patients with no PF and no pain progression, OR = 1.63 (95% CI: 1.14-2.32, p = 0.007). No significant corticosteroids effect was observed for pain progression (p = ns) and late PF occurrence (p = ns). Conclusion Prophylactic corticosteroids reduced the incidence of early PF, the days with PF, resulting in a superior rate of patients with no PF and no pain progression, but with no significant benefit for reducing pain progression or late PF occurrence.
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Affiliation(s)
- Gustavo Arruda Viani
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Juliana Fernandes Pavoni
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Ligia Issa De Fendi
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, Brazil
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van der Linden YM, Westhoff PG, Stellato RK, van Baardwijk A, de Vries K, Ong F, Wiggenraad R, Bakri B, Wester G, de Pree I, van Veelen L, Budiharto T, Schippers M, Reyners AK, de Graeff A. Dexamethasone for the Prevention of a Pain Flare After Palliative Radiation Therapy for Painful Bone Metastases: The Multicenter Double-Blind Placebo-Controlled 3-Armed Randomized Dutch DEXA Study. Int J Radiat Oncol Biol Phys 2020; 108:546-553. [DOI: 10.1016/j.ijrobp.2020.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 11/24/2022]
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Cost Effectiveness of External Beam Radiation Therapy versus Percutaneous Image-Guided Cryoablation for Palliation of Uncomplicated Bone Metastases. J Vasc Interv Radiol 2020; 31:1221-1232. [DOI: 10.1016/j.jvir.2020.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 01/17/2023] Open
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Oldenburger E, Oldenburger F, Coolbrandt A, Isebaert S, Neyens I, Sevenants A, Van Audenhove C, Haustermans K. The use of patient reported outcome measures (PROMs) in palliative radiotherapy: A topical review. Radiother Oncol 2020; 149:94-103. [DOI: 10.1016/j.radonc.2020.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 01/11/2023]
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Are the MORECare guidelines on reporting of attrition in palliative care research populations appropriate? A systematic review and meta-analysis of randomised controlled trials. BMC Palliat Care 2020; 19:6. [PMID: 31918702 PMCID: PMC6953282 DOI: 10.1186/s12904-019-0506-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Palliative care trials have higher rates of attrition. The MORECare guidance recommends applying classifications of attrition to report attrition to help interpret trial results. The guidance separates attrition into three categories: attrition due to death, illness or at random. The aim of our study is to apply the MORECare classifications on reported attrition rates in trials. METHODS A systematic review was conducted and attrition classifications retrospectively applied. Four databases, EMBASE; Medline, CINHAL and PsychINFO, were searched for randomised controlled trials of palliative care populations from 01.01.2010 to 08.10.2016. This systematic review is part of a larger review looking at recruitment to randomised controlled trials in palliative care, from January 1990 to early October 2016. We ran random-effect models with and without moderators and descriptive statistics to calculate rates of missing data. RESULTS One hundred nineteen trials showed a total attrition of 29% (95% CI 28 to 30%). We applied the MORECare classifications of attrition to the 91 papers that contained sufficient information. The main reason for attrition was attrition due to death with a weighted mean of 31.6% (SD 27.4) of attrition cases. Attrition due to illness was cited as the reason for 17.6% (SD 24.5) of participants. In 50.8% (SD 26.5) of cases, the attrition was at random. We did not observe significant differences in missing data between total attrition in non-cancer patients (26%; 95% CI 18-34%) and cancer patients (24%; 95% CI 20-29%). There was significantly more missing data in outpatients (29%; 95% CI 22-36%) than inpatients (16%; 95% CI 10-23%). We noted increased attrition in trials with longer durations. CONCLUSION Reporting the cause of attrition is useful in helping to understand trial results. Prospective reporting using the MORECare classifications should improve our understanding of future trials.
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Fabregat C, Almendros S, Navarro‐Martin A, Gonzalez J. Pain Flare‐Effect Prophylaxis With Corticosteroids on Bone Radiotherapy Treatment: A Systematic Review. Pain Pract 2019; 20:101-109. [DOI: 10.1111/papr.12823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/04/2019] [Accepted: 07/12/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Carles Fabregat
- Medical Oncology Department Catalan Institute of Oncology L'Hospitalet de Llobregat Barcelona Spain
| | - Sonia Almendros
- Radiation Oncology Department Catalan Institute of Oncology L'Hospitalet de Llobregat Barcelona Spain
| | - Arturo Navarro‐Martin
- Radiation Oncology Department Catalan Institute of Oncology L'Hospitalet de Llobregat Barcelona Spain
| | - Jesús Gonzalez
- Palliative Care Unit Catalan Institute of Oncology L'Hospitalet de Llobregat Barcelona Spain
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Use of corticosteroids for pain control in cancer patients with bone metastases: a comprehensive literature review. Curr Opin Support Palliat Care 2018; 11:78-87. [PMID: 28306570 DOI: 10.1097/spc.0000000000000263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite a limited understanding of the exact mechanism, corticosteroids are commonly employed for pain control in patients with bone metastases. The aim of this review was to evaluate the efficacy of corticosteroid-mediated pain control in patients with bone metastases associated with solid cancers. RECENT FINDINGS A literature search was conducted using OVID MEDLINE and Embase databases (from 1946 up to July 19, 2016). Studies involving patients with bone metastases receiving corticosteroids as the primary means of pain control were included. Screening and data extraction were conducted by paired reviewers, with consensus established by discussion, or a third adjudicator. A total of 12 studies were included. Rates of pain relief achieved with corticosteroid use varied from 30 to 70%, but generally reflected moderate pain control. Corticosteroid use significantly reduced the incidence of pain flare alongside radiotherapy, reportedly by almost half of baseline pain severity. Adverse events were not documented consistently across studies, though grade two to three hyperglycemia was noted in approximately 2% of patients by some studies. SUMMARY Recent evidence suggests that short-term corticosteroid use may provide moderate pain and pain flare control with radiotherapy for patients with bone metastases. The risk of developing adverse effects should be carefully considered prior to therapy initiation on a case-by-case basis.
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Odonkor CA, Kim G, Erdek M. Global cancer pain management: a systematic review comparing trials in Africa, Europe and North America. Pain Manag 2017; 7:299-310. [PMID: 28699421 DOI: 10.2217/pmt-2016-0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM Despite the rise in cancer survivorship, few reviews have examined the quality of studies of cancer pain management and practices around the globe. With a void in trials spanning multiple geographical settings, this review evaluates the quality of cancer trials across three continents. MATERIALS & METHODS A literature review and search of established databases was conducted to identify eligible studies. The Cochrane method, the Jadad Score and a cancer pain-specific ad hoc tool were used to evaluate quality of studies. RESULTS Eighteen studies representing a total of 4693 individuals were included in the review. Study quality correlated positively with study sample size and palliative care index. Trials in all three continents were prone to use opioids for pain management, whereas trials in Europe and North America utilized other adjuvant therapies such as antidepressants and steroids. CONCLUSION This review underscores the need for better multidimensional quality assessment tools for cancer pain trials.
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Affiliation(s)
- Charles A Odonkor
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Gabriel Kim
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC 20059, USA
| | - Michael Erdek
- Division of Pain Medicine, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Kougioumtzopoulou A, Zygogianni A, Liakouli Z, Kypraiou E, Kouloulias V. The role of radiotherapy in bone metastases: A critical review of current literature. Eur J Cancer Care (Engl) 2017. [PMID: 28631284 DOI: 10.1111/ecc.12724] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiotherapy is considered the treatment of choice for painful bone metastases. However, novel modalities of radiotherapy have emerged in the concept of oligometastasic disease. In addition, the increase of overall survival of patients with bone metastatic disease in the last decades due to systemic treatments has issued the silent topic of re-irradiation. The aim of this manuscript was to present a current thorough search of relevant literature. Originally, 6,087 articles revealed from PubMed database related to radiotherapy and bone metastases. The first objective was to identify prospective randomised phase III studies dealing with bone metastases and which treated primary with radiotherapy. Abstracts and non-English citations were excluded. Twenty-three phase III clinical trials, 17 prospective studies and eight meta-analysis/systemic reviews matching with these criteria, were identified. Eleven randomised studies were comparing single dose fraction to multi-fraction schedules of radiotherapy. The overall response rates and complete response rates were not significant between the two arms. Re-irradiations rates were significantly higher for the single dose fraction arms. Stereotactic radiotherapy showed excellent tumour control rates more than 80%. All trials showed the equivalence of either single or multi-fractionated radiotherapy for metastatic bone lesions. Stereotactic irradiation is feasible and safe for oligometastatic disease. However, it seems that the single fraction of 8 Gy is superior to 4 Gy, in terms of efficacy.
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Affiliation(s)
- A Kougioumtzopoulou
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Zygogianni
- First Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Z Liakouli
- First Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Kypraiou
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - V Kouloulias
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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van den Beuken-van Everdingen MH, de Graeff A, Jongen JL, Dijkstra D, Mostovaya I, Vissers KC. Pharmacological Treatment of Pain in Cancer Patients: The Role of Adjuvant Analgesics, a Systematic Review. Pain Pract 2016; 17:409-419. [DOI: 10.1111/papr.12459] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/23/2016] [Accepted: 03/14/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Marieke H.J. van den Beuken-van Everdingen
- Centre of Expertise for Palliative Care; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Anaesthesiology and Pain Management; Maastricht University Medical Centre; Maastricht the Netherlands
| | - Alexander de Graeff
- Department of Internal Medicine; University Medical Centre; Utrecht the Netherlands
| | - Joost L.M. Jongen
- Department of Neurology; Erasmus Medical Centre; Rotterdam the Netherlands
| | | | - Irina Mostovaya
- Knowledge Institute of Medical Specialists; Federation of Medical Specialists; Utrecht the Netherlands
| | - Kris C. Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine; Radboud University Medical Centre; Nijmegen the Netherlands
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Chow E, Meyer RM, Ding K, Nabid A, Chabot P, Wong P, Ahmed S, Kuk J, Dar AR, Mahmud A, Fairchild A, Wilson CF, Wu JSY, Dennis K, Brundage M, DeAngelis C, Wong RKS. Dexamethasone in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a double-blind, randomised placebo-controlled, phase 3 trial. Lancet Oncol 2015; 16:1463-1472. [PMID: 26489389 DOI: 10.1016/s1470-2045(15)00199-0] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pain flare occurs after palliative radiotherapy, and dexamethasone has shown potential for prevention of such flare. We aimed to compare the efficacy of dexamethasone with that of placebo in terms of reduction of incidence of pain flare. METHODS In this double-blind, randomised, placebo-controlled phase 3 trial, patients from 23 Canadian centres were randomly allocated (1:1) with a web-based system and minimisation algorithm to receive either two 4 mg dexamethasone tablets or two placebo tablets taken orally at least 1 h before the start of radiation treatment (a single 8 Gy dose to bone metastases; day 0) and then every day for 4 days after radiotherapy (days 1-4). Patients were eligible if they had a non-haematological malignancy and bone metastasis (or metastases) corresponding to the clinically painful area or areas. Patients reported their worst pain scores and opioid analgesic intake before treatment and daily for 10 days after radiation treatment. They completed the European Organisation for Research and Treatment of Cancer (EORTC) quality of life QLQ-C15-PAL, the bone metastases module (EORTC QLQ-BM22), and the Dexamethasone Symptom Questionnaire at baseline, and at days 10 and 42 after radiation treatment. Pain flare was defined as at least a two-point increase on a scale of 0-10 in the worst pain score with no decrease in analgesic intake, or a 25% or greater increase in analgesic intake with no decrease in the worst pain score from days 0-10, followed by a return to baseline levels or below. Primary analysis of incidence of pain flare was by intention-to-treat (patients with missing primary data were classified as having pain flare). This study is registered with ClinicalTrials.gov, number NCT01248585, and is completed. FINDINGS Between May 30, 2011, and Dec 11, 2014, 298 patients were enrolled. 39 (26%) of 148 patients randomly allocated to the dexamethasone group and 53 (35%) of 150 patients in the placebo group had a pain flare (difference 8·9%, lower 95% confidence bound 0·0, one-sided p=0·05). Two grade 3 and one grade 4 biochemical hyperglycaemic events occurred in the dexamethasone group (without known clinical effects) compared with none in the placebo group. The most common adverse events were bone pain (61 [41%] of 147 vs 68 [48%] of 143), fatigue (58 [39%] of 147 vs 49 [34%] of 143), constipation (47 [32%] of 147 vs 37 [26%] of 143), and nausea (34 [23%] of 147 vs 34 [24%] of 143), most of which were mild grade 1 or 2. INTERPRETATION Dexamethasone reduces radiation-induced pain flare in the treatment of painful bone metastases. FUNDING The NCIC CTG's programmatic grant from the Canadian Cancer Society Research Institute.
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Affiliation(s)
- Edward Chow
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
| | - Ralph M Meyer
- Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, ON, Canada
| | - Keyue Ding
- NCIC Clinical Trials Group, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Abdenour Nabid
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Philip Wong
- Centre Hospitalier de L'Université de Montréal, Montreal, QC, Canada
| | | | - Joda Kuk
- Grand River Regional Cancer Centre, Grand River Hospital, Kitchener, ON, Canada
| | - A Rashid Dar
- London Regional Cancer Program, London, ON, Canada
| | - Aamer Mahmud
- Cancer Centre of Southeastern Ontario, Kingston General Hospital, Kingston, ON, Canada
| | | | - Carolyn F Wilson
- NCIC Clinical Trials Group, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Jackson S Y Wu
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Kristopher Dennis
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Carlo DeAngelis
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Rebecca K S Wong
- Princess Margaret Hospital, Radiation Medicine Program, Ontario Cancer Institute, University of Toronto, Toronto, ON, Canada
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Ellsworth S. Methylprednisolone for the prophylaxis of pain flare: commentary on Yousef and El-mashad. J Pain Symptom Manage 2014; 48:759. [PMID: 25193607 DOI: 10.1016/j.jpainsymman.2014.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Susannah Ellsworth
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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McDonald R, Chow E, Rowbottom L, DeAngelis C, Soliman H. Incidence of pain flare in radiation treatment of bone metastases: A literature review. J Bone Oncol 2014; 3:84-9. [PMID: 26909303 PMCID: PMC4723641 DOI: 10.1016/j.jbo.2014.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/07/2014] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Pain flare is a temporary increase in pain and is a potential side effect of radiotherapy treatment. However, its incidence has been reported only in recent studies, and with great variability. A few studies have reported on the use of dexamethasone as a prophylactic agent in the prevention of pain flare. The objective of this study is to present a review of the available literature regarding the incidence of pain flare and use of dexamethasone as a preventative measure. METHODS A literature search was conducted in PubMed using subject keywords including: "radiation therapy", "stereotactic radiation therapy", "bone metastases", "pain flare", and "dexamethasone". The search was limited to English only but not restricted to any time period. Additionally, a search was also conducted in the American Society for Therapeutic Radiology and Oncology (ASTRO) 2014 book of published abstracts. Inclusion criteria were primary studies published with full text and/or abstracts only. Letters to the editor were excluded. RESULTS A total of 11 studies were selected, two of which were abstracts published by ASTRO in 2014. Seven articles investigated pain flare and/or dexamethasone use for conventional external beam radiation therapy (EBRT) while the remaining four investigated stereotactic body radiation therapy (SBRT). Pain flare incidence ranged from 2 to 44% for EBRT and 10 to 68% in SBRT. The use of dexamethasone also showed to be effective in both the prophylaxis and treatment of pain flare. CONCLUSIONS Pain flare has been established as an acute toxicity of both EBRT and SBRT, although its incidence is widely variable due to differences in data collection. The use of dexamethasone in the prophylaxis of pain flare is efficacious. Future studies are required in order to both optimize the reporting of pain and the dexamethasone regimens in the prevention of pain flare.
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Affiliation(s)
| | | | | | | | - Hany Soliman
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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