Analysis of predictors of pain response in patients with bone metastasis undergoing palliative radiotherapy: Does age matter?. Issue 4 (23rd May 2018)

• Record Type: Journal Article
• Authors: Cacicedo, Jon; Gómez‐Iturriaga, Alfonso; Navarro, Arturo; Morillo, Virginia; Willisch, Patricia; Lopez‐Guerra, Jose Luis; Illescas, Ana; Casquero, Francisco; Del Hoyo, Olga; Ciervide, Raquel; Martinez‐Indart, Lorea; Bilbao, Pedro; Rades, Dirk
• Is Part Of: Journal of medical imaging and radiation oncology. Volume 62:Issue 4(2018:Aug.)
• Page Start: 578
• Page End: 584
• Publication Date: 2018-05-23
• Subjects: bone metastases -- elderly -- metastasis -- pain -- palliative radiotherapy; Radiology, Medical -- Periodicals; Radiology, Medical -- Australasia -- Periodicals; 616.0757
• DOI: 10.1111/1754-9485.12749
• Languages: English
• ISSNs: 1754-9477

Abstract

Abstract: Introduction: To evaluate whether age is a predictor of pain response after radiotherapy for painful bone metastasis (BM). Methods: Between June 2010 and June 2014, 204 patients with BM undergoing palliative radiotherapy participated in a multicentre prospective study. Patients completed the Brief Pain Inventory (BPI) to rate the intensity pain (from 0 to 10) at baseline and 4 weeks after radiotherapy. To determine which variables predicted pain response and particularly whether age is a predictor, logistic regression analysis was used. Baseline variables considered were: age (≤65/66–75/>75 years), sex, Eastern Cooperative Oncology Group performance status (0–1/≥2), pretreatment pain score (≤4/5–7/≥8), radiotherapy (single/multiple fraction), primary tumour location, visceral metastases (yes/no), concomitant systemic chemotherapy and bisphosphonate use (yes/no). Results: Pain response was assessed in the 128 patients who completed BPI pretreatment and at 4 weeks after radiotherapy. According to univariate analysis, pain response was better in over 75‐year‐olds than younger patients: (OR, 3.2; 95% CI, 1.1–9.1; P = 0.031). Response was better in patients receiving multiple fractions rather than a single fraction of 8 Gy (OR, 2.8; 95% CI, 1.2–6.1; P = 0.01), and in patients with a pretreatment pain score ≥8 vs ≤7 (OR, 2.4; 95% CI, 1.1–5.0; P = 0.017). No other variables were significant. Multivariate analysis showed that treatment schedule (OR, 3.4; 95% CI 1.4–7.9; P = 0.004) and pre‐radiotherapy pain score (OR, 2.8; 95% CI 1.3–6.3; P = 0.009) were the only independent predictors of pain response. Conclusion: All patients with painful bone metastasis should be referred for palliative radiotherapy to relieve the pain regardless of age. Therefore, an older age should not be a reason to withhold palliative radiation treatment.