FROM THE RADIUMCENTER, FINSENINSTITUTET, STRANDBOULEVARDEN 49, DK-2100 COPEN-
Acta Oncol 1976.15:337-339. Downloaded from informahealthcare.com by 128.123.115.39 on 10/25/14. For personal use only.
HAGEN, DENMARK.
SINGLE-DOSE IRRADIATION OF BONE METASTASES N.-H. JENSEN and K. ROESDAHL Single-dose irradiation has been reported to be a useful tool in the management of widespread metastatic disease (DELCLOS & JOHNSON 1964, VARGHAet coll. 1969, FLETCHER 1973). For a period of 4 months this mode of approach was applied to 64 patients with painful, radiographically verified bone metastases. Patients with imminent fracture through the metastasis were excluded. Sixty-six of the lesions were osteolytic, 30 osteosclerotic and 8 mixed. Of a total of 104 irradiations, 84 were given with high energy photons (mainly 6oCo),while 200 kV roentgen radiation was applied in 16 and betatron electrons in 4. In 54 of the 64 patients the primary tumour was carcinoma of the breast, in the remaining 10 cases carcinoma of the prostate, the kidney or the thyroid. Of the total material 8 patients (12 per cent) were less than 50 years old, 16 (25 per cent) between 50 and 60, 19 (30 per cent) between 60 and 70, and the remaining 21 (33 per cent) more than 70 years old. The calculated tumour doses appear in the Table. The maximum tumour dose was 7.46 Gy (746 rad), the minimum 3.02 Gy (302 rad). Field sizes varied between 32 and 400 cm2, 15 per cent were larger than 200 cm2 and 15 per cent smaller than 80 cm2. There was a marked tendency towards rzciprocal connection between the dose given and the field size. The follow-up period after treatment varied between 2 weeks and 15 months with Submitted {or publication 1 September 1975. Acta Radiologica Therapy Physics Biology 15 (1976) F a x . 4 August
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338
N.-H. JENSEN AND K. ROESDAHL
Table
Acta Oncol 1976.15:337-339. Downloaded from informahealthcare.com by 128.123.115.39 on 10/25/14. For personal use only.
Tumour dose in single-dose treatments Tumour dose (Gy)
No. of treatments
l
5 21 34 34 10
Total
104
46 per cent of the patients exhibiting a follow-up time of more than 6 months, and 23 per cent of more than 12 months. Within 4 months following treatment 49 per cent of the patients were dead. Results and Discussion All patients were seen in the out-patient clinic 2 weeks after treatment for assessment of response, skin reaction and other side effects. Later examinations were performed in 2 to 4 weeks interval, depending on the general condition. None failed t o report. The response was classified into 3 groups: (1) free of pain: all symptoms from the irradiated bone metastases disappeared, and no further need for analgesics, (2) improvement: pain diminished and reduction of analgesics, and (3) no effect. Two weeks following treatment 25 per cent (26 patients) presented without pain and 54 per cent (56) had improved; no effect was encountered in 21 per cent (22 patients). When last seen 15 per cent (16 patients) had still pains, while 23 per cent (24) indicated relief and 62 per cent (64 patients) were free of pain. No difference in response rate existed between long-time and short-time survivors. No correlation between dose and response was found; thus the results corresponded to those of VARGHAet coll. Furthermore no relationship existed neither between the microscopic type of the primary tumour and the response to single-dose treatment nor between age and effect. Retreatment (5 irradiations/week) to previously irradiated areas was given to 6 patients, of whom 5 responded well with no side effects. Systemic reactions occurred in one instance (nausza after pelvic irradiation to a field measuring 400 cm2, the tumour dose amounting to 6.15 Gy (615 rad). The inconvenience disappeared in a few days. Twenty-nine patients received single-dose irradiation of more than one area. It appeared that if a good response was obtained in one site, the same effect could be expected in another site with the same dose. Erythema developed in 8 of 16 irradia-
Acta Oncol 1976.15:337-339. Downloaded from informahealthcare.com by 128.123.115.39 on 10/25/14. For personal use only.
SINGLE-DOSE IRRADIATION OF BONE METASTASES
339
tions with roentgen rays, in 6 of 84 with high energy photons and in 2 of 4 treatments with electrons. In no case a moist reaction occurred. Adjuvant hormone therapy was given to 64 per cent of the patients; the majority were treated with androgens. Non-hormone chemotherapy was administered to 5 patients during the follow-up period because of further dissemination; all were and remained pain-free in the previously treated areas. N o difference as regards singledose response was established between the androgen-treated and the non-hormonetreated groups. The single-dose therapy was not administered to hormone-treated patients as long as they were free of pains with this therapy. The follow-up time is rather short, but the preliminary results seem to indicate that in the majority of patients with bone metastases from a malignant tumour, a single exposure of irradiation is adequate to control pain.
Conclusion Bearing in mind that almost half of the patients died of their disease within 4 months following the single-dose treatment, it might be worth-while to emphasize the possibility of relieving an incurable patient with a malignant tumour from intolerable pain without intruding too much on the short remaining lifespan. The economic, psychologic and social advantages which this implies should not be disregarded.
SUMMARY The results of single-dose irradiation of 64 patients with painful bone metastases are reported. In about two thirds of the patients complete disappearance of pain was obtained.
ZUSAMMENFASSUNG Die Ergebnisse einer einzelnen Bestrahlungsdosis bei 64 Patienten mit schmerzhaften Knochenmetastasen werden berichtet. Bei etwa zwei Dritteln dieser Patienten wurde ein vollstandiges Verschwinden der Schrnerzen erreicht.
RESUME Prtsentstion des rtsultats de l’irradiation par une dose unique de 64 malades ayant des mttastases osseuses douloureuses. On a obtenu une disparition complete de la douleur chez environ les deux tiers des malades.
REFERENCES DELCLOS L. and JOHNSON G. C.: Palliative irradiation in breast cancer. Radiology 83 (1964), 272. FLETCHER G. H.: Textbook of Radiotherapy. Second edition, p. 493. Lea & Febiger, Philadelphia 1973. VARGHAZ. O., GLICKSMAN A. S. and BOLAND J.: Single-doseradiation therapy in the palliation of metastatic disease. Radiology 93 (1969), 1181.
Acta Oncol 1976.15:337-339. Downloaded from informahealthcare.com by 128.123.115.39 on 10/25/14. For personal use only.
HAGEN, DENMARK.
SINGLE-DOSE IRRADIATION OF BONE METASTASES N.-H. JENSEN and K. ROESDAHL Single-dose irradiation has been reported to be a useful tool in the management of widespread metastatic disease (DELCLOS & JOHNSON 1964, VARGHAet coll. 1969, FLETCHER 1973). For a period of 4 months this mode of approach was applied to 64 patients with painful, radiographically verified bone metastases. Patients with imminent fracture through the metastasis were excluded. Sixty-six of the lesions were osteolytic, 30 osteosclerotic and 8 mixed. Of a total of 104 irradiations, 84 were given with high energy photons (mainly 6oCo),while 200 kV roentgen radiation was applied in 16 and betatron electrons in 4. In 54 of the 64 patients the primary tumour was carcinoma of the breast, in the remaining 10 cases carcinoma of the prostate, the kidney or the thyroid. Of the total material 8 patients (12 per cent) were less than 50 years old, 16 (25 per cent) between 50 and 60, 19 (30 per cent) between 60 and 70, and the remaining 21 (33 per cent) more than 70 years old. The calculated tumour doses appear in the Table. The maximum tumour dose was 7.46 Gy (746 rad), the minimum 3.02 Gy (302 rad). Field sizes varied between 32 and 400 cm2, 15 per cent were larger than 200 cm2 and 15 per cent smaller than 80 cm2. There was a marked tendency towards rzciprocal connection between the dose given and the field size. The follow-up period after treatment varied between 2 weeks and 15 months with Submitted {or publication 1 September 1975. Acta Radiologica Therapy Physics Biology 15 (1976) F a x . 4 August
22 - 765831
337
338
N.-H. JENSEN AND K. ROESDAHL
Table
Acta Oncol 1976.15:337-339. Downloaded from informahealthcare.com by 128.123.115.39 on 10/25/14. For personal use only.
Tumour dose in single-dose treatments Tumour dose (Gy)
No. of treatments
l
5 21 34 34 10
Total
104
46 per cent of the patients exhibiting a follow-up time of more than 6 months, and 23 per cent of more than 12 months. Within 4 months following treatment 49 per cent of the patients were dead. Results and Discussion All patients were seen in the out-patient clinic 2 weeks after treatment for assessment of response, skin reaction and other side effects. Later examinations were performed in 2 to 4 weeks interval, depending on the general condition. None failed t o report. The response was classified into 3 groups: (1) free of pain: all symptoms from the irradiated bone metastases disappeared, and no further need for analgesics, (2) improvement: pain diminished and reduction of analgesics, and (3) no effect. Two weeks following treatment 25 per cent (26 patients) presented without pain and 54 per cent (56) had improved; no effect was encountered in 21 per cent (22 patients). When last seen 15 per cent (16 patients) had still pains, while 23 per cent (24) indicated relief and 62 per cent (64 patients) were free of pain. No difference in response rate existed between long-time and short-time survivors. No correlation between dose and response was found; thus the results corresponded to those of VARGHAet coll. Furthermore no relationship existed neither between the microscopic type of the primary tumour and the response to single-dose treatment nor between age and effect. Retreatment (5 irradiations/week) to previously irradiated areas was given to 6 patients, of whom 5 responded well with no side effects. Systemic reactions occurred in one instance (nausza after pelvic irradiation to a field measuring 400 cm2, the tumour dose amounting to 6.15 Gy (615 rad). The inconvenience disappeared in a few days. Twenty-nine patients received single-dose irradiation of more than one area. It appeared that if a good response was obtained in one site, the same effect could be expected in another site with the same dose. Erythema developed in 8 of 16 irradia-
Acta Oncol 1976.15:337-339. Downloaded from informahealthcare.com by 128.123.115.39 on 10/25/14. For personal use only.
SINGLE-DOSE IRRADIATION OF BONE METASTASES
339
tions with roentgen rays, in 6 of 84 with high energy photons and in 2 of 4 treatments with electrons. In no case a moist reaction occurred. Adjuvant hormone therapy was given to 64 per cent of the patients; the majority were treated with androgens. Non-hormone chemotherapy was administered to 5 patients during the follow-up period because of further dissemination; all were and remained pain-free in the previously treated areas. N o difference as regards singledose response was established between the androgen-treated and the non-hormonetreated groups. The single-dose therapy was not administered to hormone-treated patients as long as they were free of pains with this therapy. The follow-up time is rather short, but the preliminary results seem to indicate that in the majority of patients with bone metastases from a malignant tumour, a single exposure of irradiation is adequate to control pain.
Conclusion Bearing in mind that almost half of the patients died of their disease within 4 months following the single-dose treatment, it might be worth-while to emphasize the possibility of relieving an incurable patient with a malignant tumour from intolerable pain without intruding too much on the short remaining lifespan. The economic, psychologic and social advantages which this implies should not be disregarded.
SUMMARY The results of single-dose irradiation of 64 patients with painful bone metastases are reported. In about two thirds of the patients complete disappearance of pain was obtained.
ZUSAMMENFASSUNG Die Ergebnisse einer einzelnen Bestrahlungsdosis bei 64 Patienten mit schmerzhaften Knochenmetastasen werden berichtet. Bei etwa zwei Dritteln dieser Patienten wurde ein vollstandiges Verschwinden der Schrnerzen erreicht.
RESUME Prtsentstion des rtsultats de l’irradiation par une dose unique de 64 malades ayant des mttastases osseuses douloureuses. On a obtenu une disparition complete de la douleur chez environ les deux tiers des malades.
REFERENCES DELCLOS L. and JOHNSON G. C.: Palliative irradiation in breast cancer. Radiology 83 (1964), 272. FLETCHER G. H.: Textbook of Radiotherapy. Second edition, p. 493. Lea & Febiger, Philadelphia 1973. VARGHAZ. O., GLICKSMAN A. S. and BOLAND J.: Single-doseradiation therapy in the palliation of metastatic disease. Radiology 93 (1969), 1181.
