5.2.1.1 Pain Relief with Localized Radiation Therapy

Radiation is commonly administered to a localized bone metastasis. An analysis of therapeutic results is complicated by variation in the location and extent of bone metastasis, primary histology, individual differences (including patients' underlying medical conditions), and co-administered treatments. Concurrent analgesic use is frequently a confounding, poorly quantified variable in many accounts of pain control during local radiation of a metastasis. Most retrospective and prospective studies report that 75 percent or more of patients obtain relief from pain and that about half of those who achieve relief become pain-free (Nielsen, Munro, and Tannock, 1991). However, selection bias cannot be excluded; valid and reliable pain assessment instruments were not commonly used.

The literature is divided on appropriate fractionation (Blitzer/ 1985; Hoskin, 1988; Tong, Gillick, and Hendrickson, 1982). Protracted regimens of more than lC treatments may be more appropriate for patients with life expectancies of longer than 6 months to reduce potential late radiation effects or acute effects such as nausea if critical structures such as the stomach have to be included in the radiation field. For patients with a more limited life expectancy, radiation can be administered in fewer fractions, depending on the patients clinical status (Lawton and Maher, 1991; Maher, Coia, Duncan, et al., 1992). These later regimens result in effective palliation in over 70 percent of patients at 3-months' followup, with negligible complications when radiation portals are localized (Arcangeli, Micheli, Archangeli, et al., 1989; Bates, Yarnold, Blitzer, et al., 1992; Blitzer, 1985; Tong, Gillick, and Henderson, 1982).


Related Chunks

NONPHARMACOLOGIC INTERVENTIONS: INVASIVE THERAPIES

Radiation Therapy

Bone Metastases

Wide-Field Radiation Therapy

Radiopharmaceuticals

Plexopathy

Other Therapeutic Applications

Surgical Management of Pain due to Primary or Metastatic Tumor

Index