Important Studies Flashcards
Fractionation?
University of Toronto. “Chow et al, Clin Oncol, 2012
Chow et al, Lancet Oncol, 2014, Chow et al, Radiother Oncol, 2019”. Bone metastases. Meta-analysis of 29 trials in most recent publication. “There is equivalent ORR, CR, pathologic fractions and cord compression efficacy between regimens. Multifraction has lower re-treatment rate. Authors rec no additional funding to be spent on trials.”
RTOG 9714. Hartsell et al, JNCI, 2005. Breast or prostate bone metastasis, 1-3 sites, moderate to severe pain. “→8 Gy vs. →30 Gy/10 fx”. Single fx and 10 fx RT were equivalent at 3 months with few adverse effects. There were retreatments with single fx arm but less toxicity.
RTOG 7402. Tong et al, Cancer, 1982. Painful bony mets, no prior RT to site. Stratified single mets and multiple mets (with one painful site). “Single met: 40.5 Gy/15 fx vs. 20/5. Multiple mets: 30/10 vs. 15/5 vs. 20/5 vs. 25/5.” Low-dose short-course RT is equivalent to long-course for pain relief.
SBRT vs. multi fraction?
MDACC. Nguyen et al, JAMA Oncol, 2019. Bone metastases. “→single fx SBRT vs. →30 Gy/ 10 fx (12 Gy for ≥4 cm, 16 Gy for <4 cm)”. Single fx SBRT to bone metastases improved pain control compared to 30 Gy/10 fx.
Reirradiation?
University Medical Center Utrecht, the Netherlands. Huisman et al, IJROBP, 2012. Bone metastases treated with repeat RT, most with single fx, after initial dose of 4-8 Gy x 1. “Pain response with reirradiation 58%
Subtantial heterogeneity between studies”.
Dexamethasone?
University of Toronto. Chow et al, Lancet Oncol, 2015. 8 mg dexamethasone at least 1 hour before start of RT (dose single 8 Gy in all) then every day for 4 days after RT vs. placebo. pain flares improved with dexamethasone: 26% vs. 35%, p=0.05
Dutch Dexa. van der Linden et al, IJROBP, 2020. bone metastasis with pain. “8 mg dex prior to RT, then daily x3 vs.8 mg dex prior to RT, then placebo x3 vs. placebo x4”.”→8 mg dex prior to RT, then daily x3 vs.
→8 mg dex prior to RT, then placebo x3 vs.
→placebo x4”
