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Prophylactic dexamethasone effectively reduces the incidence of pain flare following spine stereotactic body radiotherapy (SBRT): a prospective observational study

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Abstract

Purpose

The purpose of this study was to determine the incidence of pain flare (PF) in patients receiving spine stereotactic body radiotherapy (SBRT) treated with prophylactic oral dexamethasone (DEX) 1 h before and for 4 days following SBRT.

Methods

Forty-seven patients were accrued on this prospective observational study. The first cohort of 24 patients was treated with 4 mg, while a second cohort of 23 patients treated with 8 mg of DEX. The Brief Pain Inventory (BPI) was used to score pain and functional interference each day during SBRT and for 10 days following. Comparisons between the 4 and 8 mg cohorts, in addition to our previously reported steroid naïve patients post SBRT (n = 41), were also performed.

Results

The total incidence of PF was 19 % (9/47). The incidence in the 4 and 8 mg cohorts was 25 % (6/24) and 13 % (3/23), respectively, and the difference was not statistically significant (p = 0.46). Comparing functional interference, the 4 mg cohort had better profile in walking ability (p < 0.005) and relationships with others (p < 0.035) compared to the 8 mg cohort. Compared to our previously reported steroid naïve cohort, prophylactic DEX significantly reduced the incidence of PF (68 vs. 19 %, p < 0.0001, respectively), patients had lower worst pain scores, and improved general activity interference outcome.

Conclusion

We recommend prophylactic DEX for patients treated with spine SBRT. Our current practice is based on the 4 mg protocol primarily due to the improved functional interference outcomes. A randomized trial is required to finalize the optimal regimen and schedule.

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Acknowledgments

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Conflict of interests

Dr. Arjun Sahgal has received honorarium for previous educational seminars for Medtronic Kyphoplasty division and for Elekta AB and has research grants from Elekta AB, otherwise, there are no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada

    Luluel Khan, Andrew Chiang, Liying Zhang, Isabelle Thibault, Gillian Bedard, Erin Wong, Andrew Loblaw, Hany Soliman, Edward Chow & Arjun Sahgal

  2. Department of Neurosurgery and Spinal Program, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

    Michael G. Fehlings

Authors
  1. Luluel Khan
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  2. Andrew Chiang
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  3. Liying Zhang
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  6. Erin Wong
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  7. Andrew Loblaw
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  9. Michael G. Fehlings
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  10. Edward Chow
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  11. Arjun Sahgal
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Correspondence to Arjun Sahgal.

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Khan, L., Chiang, A., Zhang, L. et al. Prophylactic dexamethasone effectively reduces the incidence of pain flare following spine stereotactic body radiotherapy (SBRT): a prospective observational study. Support Care Cancer 23, 2937–2943 (2015). https://doi.org/10.1007/s00520-015-2659-z

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  • DOI: https://doi.org/10.1007/s00520-015-2659-z

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