Effectiveness of Reirradiation for Painful Bone Metastases: A Systematic Review and Meta-Analysis

• Published in: International journal of radiation oncology, biology, physics Vol. 84; no. 1; pp. 8 - 14
• Main Authors: Huisman, Merel, M.D, van den Bosch, Maurice A.A.J., M.D., Ph.D, Wijlemans, Joost W., M.D, van Vulpen, Marco, M.D., Ph.D, van der Linden, Yvette M., M.D., Ph.D, Verkooijen, Helena M., M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2012; Elsevier
• Subjects: Biological and medical sciences; Bone metastases; Bone Neoplasms - radiotherapy; Bone Neoplasms - secondary; Diseases of the osteoarticular system; Female; Hematology, Oncology and Palliative Medicine; Humans; Male; Medical sciences; METASTASES; PAIN; Pain - etiology; Pain - radiotherapy; Palliative Care - methods; Palliative treatment; PATIENTS; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Reirradiation; Retreatment; Retreatment - adverse effects; Retreatment - methods; SKELETON; Treatment Outcome; Tumors of striated muscle and skeleton; Reirradiation; Retreatment; Palliative treatment; Radiotherapy; Bone metastases; Diseases of the osteoarticular system; Malignant tumor; Review; Metaanalysis; Bone metastasis; Cancerology; Pain; Bibliographic review; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2011.10.080

Purpose Reirradiation of painful bone metastases in nonresponders or patients with recurrent pain after initial response is performed in up to 42% of patients initially treated with radiotherapy. Literature on the effect of reirradiation for pain control in those patients is scarce. In this systematic review and meta-analysis, we quantify the effectiveness of reirradiation for achieving pain control in patients with painful bone metastases. Methods and Materials A free text search was performed to identify eligible studies using the MEDLINE, EMBASE, and the Cochrane Collaboration library electronic databases. After study selection and quality assessment, a pooled estimate was calculated for overall pain response for reirradiation of metastatic bone pain. Results Our literature search identified 707 titles, of which 10 articles were selected for systematic review and seven entered the meta-analysis. Overall study quality was mediocre. Of the 2,694 patients initially treated for metastatic bone pain, 527 (20%) patients underwent reirradiation. Overall, a pain response after reirradiation was achieved in 58% of patients (pooled overall response rate 0.58, 95% confidence interval = 0.49–0.67). There was a substantial between-study heterogeneity ( I2 = 63.3%, p = 0.01) because of clinical and methodological differences between studies. Conclusions Reirradiation of painful bone metastases is effective in terms of pain relief for a small majority of patients; approximately 40% of patients do not benefit from reirradiation. Although the validity of results is limited, this meta-analysis provides a comprehensive overview and the most quantitative estimate of reirradiation effectiveness to date.