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Re-irradiation of painful bone metastases

Re-irradiation of painful bone metastases. Warszawski A., Baumgartner M., Baumann R., Bremer M., Karstens J.H., Clinic of Radiotherapy and Special Oncology. Aim:. Evaluation of a second course of radiotherapy (RT) for painful bone metastases with emphasis of overall response,

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Re-irradiation of painful bone metastases

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  1. Re-irradiation of painful bone metastases Warszawski A., Baumgartner M., Baumann R., Bremer M., Karstens J.H., Clinic of Radiotherapy and Special Oncology

  2. Aim: • Evaluation of a second course of radiotherapy (RT) for painful bone metastases with emphasis • of overall response, • duration of pain relief, and • functional state, • acute and late side effects.

  3. Patients and Methods: • retrospective Study, 6/2000-5/2006 • Re-Irradiation in 36 patients with painful bone metastases • Age: 47 to 85 years (median: 63 years) • dose of re-irradiation: • Total dose 4 to 39,6 Gy (median 26 Gy), • single doses: 1,5 to 4 Gy • Radiation schemas: • First RT course: 10x3 Gy, 15x2,5 Gy • Re-irradiation: 10x2 Gy; 7x3 Gy

  4. Patients and Methods: • Intervall RT to re-irradiation: 4 months to 8 years (median 9 months) • Histology of primary tumor: • Breast cancer 33% • Renal cell carcinoma 16% • Prostate cancer 8% • Lung cancer 8% • Site of bone metastases: • Spinal column: 56% • Other: 44%

  5. Patients and Methods: • First radiotherapy course: • pain reduction in 82%; • no pain relief in 18% • Evaluated parameters: • Total and single dose of re-irradiation • Interval RT and re-irradiation • Effect of first RT course on pain intensity • Age • Site of re-irradiation (spinal column vs. other)

  6. Results: • Pain relief after re-irradiation in 76% of patients • No change in 24% of patients

  7. Results: • Patients with pain relief after first course of radiotherapy had a significant better response after re-irradiation (p= 0,037)

  8. Side effects of re-irradiation: • Acute: 36% (13/36 patients) • Skin: 17% (6/36 patients), CTC I/II • GI: 14% (5/36 patients), CTC I/II • Fatigue symptoms: 14% (5/36 patients) • Late: One soft tissue fibrosis

  9. Conclusions: • Reirradiation of painful bone metastases is an effective method • 76 % of the re-irradiated patients had a pain relief • The appropriate indications and the optimal dose and fractionation scheme should be further explored in a prospective study

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