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Retreatment with radiotherapy for symptomatic bone, brain or visceral metastases

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Abstract

Background

The need for reirradiation in the metastatic disease appears when other modalities of treatment lose their efficacy. The aim of reirradiation in the metastatic disease is mainly palliative to control a particular symptom. However, this theoretical benefit must be confronted against the risk of an undesirable toxicity.

Materials and Methods

Experience with reirradiation for symptomatic bone, brain or visceral metastases are reviewed. Twenty-two patients were found to have a second palliative radiotherapy on the same location. Locatión of metastases were visceral in 5 (23 %) patients, brain in 4 (18 %) patients, spine in 1 (4.5 %) patient and bone metastasis other than spine in 12 (54.5 %) patients. Median dose delivered in the first treatment was 30 Gy (range 20–30 Gy) and 20 Gy for the second treatment (range 6–32.4 Gy).

Results

A good symptomatic response after first irradiation (complete response or disappearance of >50 % of symptoms) was reached in 21 (95.5 %) of the 22 patients analyzed. After second irradiation, 82 % (18 patients) achieved a good response, 3 (14 %) patients had a moderate response (relief of symptoms <50 %) whereas no response was observed in 1 (4 %) patient. Acute toxicity was limited to grade 1–2 proctitis in 2 and 3 patients after the first and second irradiation, respectively. No cases of late toxicity after the first or second irradiation were recorded.

Conclusion

A second treatment with palliative radiotherapy is feasible and well tolerated and offers the possibility of symptomatic relief in a high percentage of patients with symptomatic metastases.

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References

  1. Morris DE (2000) Clinical experience with retreatment for palliation. Semin Radiat Oncol 10(3):210–221

    Article  PubMed  CAS  Google Scholar 

  2. Nieder C, Milas L, Ang KK (2000) Tissue tolerance to reirradiation. Semin Radiat Oncol 10(3):200–209

    Article  PubMed  CAS  Google Scholar 

  3. Barton MB, Hudson HM, Delaney G, Gruver P, Liu Z (2011) Patterns of retreatment by radiotherapy. Clin Oncol (R Coll Radiol) 23(1):10–18

    Article  CAS  Google Scholar 

  4. Abusaris H, Storchi PR, Brandwijk RP, Nuyttens JJ (2011) Second re- irradiation: efficacy, dose and toxicity in patients who received three courses of radiotherapy with overlapping fields. Radiother Oncol 99(2):235–239

    Article  PubMed  Google Scholar 

  5. Maranzano E, Trippa F, Pacchiarini D et al (2005) Re-irradiation of brain metastases and metastatic spinal cord compression: clinical practice suggestions. Tumori 91(4):325–330

    PubMed  Google Scholar 

  6. Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45(2):228–247

    Article  PubMed  CAS  Google Scholar 

  7. Mithal NP, Needham PR, Hoskin PJ (1994) Retreatment with radiotherapy for painful bone metastases. Int J Radiat Oncol Biol Phys 29(5):1011–1014

    Article  PubMed  CAS  Google Scholar 

  8. Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31(5):1341–1346

    Article  PubMed  CAS  Google Scholar 

  9. Jones B, Dale RG, Deehan C, Hopkins KI, Morgan DA (2001) The role of biologically effective dose (BED) in clinical oncology. Clin Oncol (R Coll Radiol) 13(2):71–81

    CAS  Google Scholar 

  10. Rades D, Rudat V, Veninga T, Stalpers LJ, Hoskin PJ, Schild SE (2008) Prognostic factors for functional outcome and survival after reirradiation for in-field recurrences of metastatic spinal cord compression. Cancer 113(5):1090–1096

    Article  PubMed  Google Scholar 

  11. Nieder C, Grosu AL, Andratschke NH, Molls M (2006) Update of human spinal cord reirradiation tolerance based on additional data from 38 patients. Int J Radiat Oncol Biol Phys 66:1446–1449

    Article  PubMed  Google Scholar 

  12. Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed) Evaluation of chemotherapeutic agents. Columbia Univ Press, New York, p 196

    Google Scholar 

  13. Möller TR, Brorsson B, Ceberg J et al (2003) A prospective survey of radiotherapy practice 2001 in Sweden. Acta Oncol 42:387–410

    Article  PubMed  Google Scholar 

  14. Kong W, Zhang-Salomons J, Hanna TP et al (2007) A population based study of the fractionation of palliative radiotherapy for bone metastasis in Ontario. Int J Radiat Oncol Biol Phys 69:1209–1217

    Article  PubMed  Google Scholar 

  15. Esco R, Palacios A, Pardo J, Biete A, Carceller JA, Veiras C, Vazquez G, Spanish Society of Radiotherapy Oncology (2003) Infrastructure of radiotherapy in Spain: a minimal standard of radiotherapy resources. Int J Radiat Oncol Biol Phys 56(2):319–327

    Article  PubMed  CAS  Google Scholar 

  16. Nieder C, Pawinski A, Haukland E, Dokmo R, Phillipi I, Dalhaug A (2010) Estimating need for palliative external beam radiotherapy in adult cancer patients. Int J Radiat Oncol Biol Phys 76(1):207–211

    Article  PubMed  Google Scholar 

  17. Statewide Services Development Branch (2009) 2008 radiotherapy management information system report. NSW Health, Sydney

  18. Williams MV, Drinkwater KJ (2009) Radiotherapy in England in 2007: modelled demand and audited activity. Clin Oncol 21:575–590

    Article  CAS  Google Scholar 

  19. Sadikov E, Bezjak A, Yi QL, Wells W, Dawson L, Millar BA, Laperriere N (2007) Value of whole brain re-irradiation for brain metastases–single centre experience. Clin Oncol (R Coll Radiol) 19(7):532–538 Epub 2007 Jul 26

    Article  CAS  Google Scholar 

  20. Son CH, Jimenez R, Niemierko A, Loeffler JS, Oh KS, Shih HA (2011) Outcomes alter whole brain reirradiation in patients with brain metastases. Int J Radiat Oncol Biol Phys 82(2):e167–e172

    Article  PubMed  Google Scholar 

  21. Ratanatharathorn V, Powers WE, Moss WT et al (1999) Bone metastasis: review and critical analysis of random allocation trials of local field treatment. Int J Radiat Oncol Biol Plays 44:1–18

    Article  CAS  Google Scholar 

  22. Jeremic B, Shibamoto Y, Igrutinovic I (1999) Single 4 Gy re-irradiation for painful bone metastases following single fraction radiotherapy. Radiother Oncol 52:123–127

    Article  PubMed  CAS  Google Scholar 

  23. Maranzano E, Trippa F, Casale M, Anselmo P, Rossi R (2011) Reirradiation of metastatic spinal cord compression: definitive results of two randomized trials. Radiother Oncol 98(2):234–237

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Ramón y Cajal, Cta. Colmenar Viejo, km 9.100, 28034, Madrid, Spain

    R. Hernanz, A. Montero, E. Fernandez-Lizarbe, A. Polo & A. Ramos

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  1. R. Hernanz
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  2. A. Montero
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  3. E. Fernandez-Lizarbe
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  4. A. Polo
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  5. A. Ramos
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Correspondence to A. Montero.

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Hernanz, R., Montero, A., Fernandez-Lizarbe, E. et al. Retreatment with radiotherapy for symptomatic bone, brain or visceral metastases. Clin Transl Oncol 15, 72–78 (2013). https://doi.org/10.1007/s12094-012-0895-y

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  • DOI: https://doi.org/10.1007/s12094-012-0895-y

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