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Short-term pain control after palliative radiotherapy for uncomplicated bone metastases: a prospective cohort study

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Abstract

This study aimed at evaluating the efficacy of different radiotherapy (RT) fractionation regimens in managing uncomplicated painful bone metastases (BM) and identifying predictive factors for pain control. Patients with 1 to 4 symptomatic BM from any primary solid tumors and a life expectancy exceeding 3 months were included in the study and received palliative RT, with SBRT restricted in the context of oligometastatic disease or in patients with good prognosis. Pain analysis using the Brief Pain Inventory (BPI) tool was conducted at baseline, 1 and 3 months after RT. Analgesic intake was recorded as morphine-equivalent doses (OME). Pain response was assessed using the International Consensus on Palliative Radiotherapy Endpoint (ICPRE). Multivariate logistic regression analyzed patient-related, tumor-related, and treatment-related factors predicting BM pain control at 3 months post-RT. From Feb 2022 to Feb 2023, 44 patients with 65 symptomatic BM were investigated. Breast (32%) and lung (24%) tumors were the most common primary tumors. Treatment plans included 3DCRT (60%) and VMAT (40%), with a median biological effective dose for tumors (BED) of 29 Gy [14–108]. All patients completed the 3-month follow-up. Pain response rates were 62% at 1 month and 60% at 3 months. Responders had better PS ECOG scores (67%; P = 0.008) and received active systemic therapies (67%: P = 0.036). Non-responders had lower pretreatment BPI (mean: 13.7 vs. 58.2; P = 0.032), with significantly higher values after 1 month (mean: 9.1 vs. 5.3, P = 0.033). Baseline BPI (OR: 1.17; 95% CI: 1.032–1.327; P = 0.014) and BPI at 1 month (OR: 0.83; 95% CI: 0.698–0.976; P = 0.025) were independent predictors of pain response at 3 months. Our findings show that palliative RT ensured short-term pain control in patients with BM, regardless of tumor type and dose-fractionation regimen. A larger sample size and a longer follow-up could potentially identify which patients are likely to benefit most from RT, and which fractionation might be indicated for achieving a durable pain relief. A multidisciplinary approach is paramount to provide a better care to BM patients.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy

    Sofia Paola Bianchi, Pietro Pacifico, Gaia Parma, Sara Saufi, Federica Ferrario, Maria Belmonte, Elena De Ponti, Denis Panizza & Stefano Arcangeli

  2. Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy

    Sofia Paola Bianchi, Pietro Pacifico, Gaia Parma, Sara Saufi, Federica Ferrario, Maria Belmonte & Stefano Arcangeli

  3. Medical Physics Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy

    Valeria Faccenda, Elena De Ponti & Denis Panizza

  4. Clinical Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy

    Luca Sala

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  1. Sofia Paola Bianchi
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Contributions

The conceptualization and design of the study were led by SPB, PP, VF, DP and SA. Material preparation and data collection were performed by SPB, VF, PP and DP. The data analysis was performed by VF and EDP. Resources and data curation were done by GP, SS, FF, MB and LS. The first draft of the manuscript was written by SPB and VF. The final revision was performed by DP, EDP and SA, the senior authors who supervised the work. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Stefano Arcangeli.

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This study was performed in line with the principles of the Declaration of Helsinki. This is an observational study and no ethical approval is required.

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Informed consent was obtained from all individual participants included in the study.

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Bianchi, S.P., Faccenda, V., Pacifico, P. et al. Short-term pain control after palliative radiotherapy for uncomplicated bone metastases: a prospective cohort study. Med Oncol 41, 13 (2024). https://doi.org/10.1007/s12032-023-02238-9

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