Vol 26, No 2 (2021)
Research paper
Published online: 2021-03-04

open access

Page views 697
Article views/downloads 499
Get Citation

Connect on Social Media

Connect on Social Media

Prophylactic corticosteroid to prevent pain flare in bone metastases treated by radiotherapy

Gustavo Arruda Viani1, Juliana Fernandes Pavoni1, Ligia Issa De Fendi1
Rep Pract Oncol Radiother 2021;26(2):218-225.

Abstract

BACKGROUND: The aim of this study was to evaluate the effectiveness of prophylactic corticosteroids to prevent pain flare (PF) in bone metastases treated with radiotherapy performing a meta-analysis of randomized clinical trials (RCT).

MATERIALS AND METHODS: RCTs were identified on Medline, Embase, the Cochrane Library, and the proceedings of annual meetings through June 2020. We followed the PRISMA and MOOSE guidelines. A meta-analysis was performed to assess if corticosteroids reduce the PF, pain progression, and the mean of days with PF compared with the placebo. A p-value < 0.05 was considered significant.

RESULTS: Three RCTs with a total of 713 patients treated were included. The corticosteroids reduced the occurrence of early PF 20.5% (51/248) versus 32% (80/250) placebo, OR= 0.55 (95% CI: 0.36–0.82, p = 0.002). The mean days of PF were reduced to 1.6 days (95% CI: 1.3–1.9, p = 0.0001). Prophylactic corticosteroids had more patients with no PF and no pain progression, OR = 1.63 (95% CI: 1.14–2.32, p = 0.007). No significant corticosteroids effect was observed for pain progression (p = ns) and late PF occurrence (p = ns).  

CONCLUSION: Prophylactic corticosteroids reduced the incidence of early PF, the days with PF, resulting in a superior rate of patients with no PF and no pain progression, but with no significant benefit for reducing pain progression or late PF occurrence. 

 

Article available in PDF format

View PDF Download PDF file

References

  1. Løhre ET, Thronæs M, Klepstad P. Breakthrough cancer pain in 2020. Curr Opin Support Palliat Care. 2020; 14(2): 94–99.
  2. Culleton S, Kwok S, Chow E. Radiotherapy for pain. Clin Oncol (R Coll Radiol). 2011; 23(6): 399–406.
  3. Chow R, Hoskin P, Schild SE, et al. Single vs multiple fraction palliative radiation therapy for bone metastases: Cumulative meta-analysis. Radiother Oncol. 2019; 141: 56–61.
  4. Goldfinch R, White N. An investigation into the incidence of pain flare in patients undergoing radiotherapy for symptomatic bone metastases. Radiography (Lond). 2018; 24(3): 192–195.
  5. McDonald R, Chow E, Rowbottom L, et al. Incidence of pain flare in radiation treatment of bone metastases: A literature review. J Bone Oncol. 2014; 3(3-4): 84–89.
  6. Gomez-Iturriaga A, Cacicedo J, Navarro A, et al. Incidence of pain flare following palliative radiotherapy for symptomatic bone metastases: multicenter prospective observational study. BMC Palliat Care. 2015; 14: 48.
  7. Hird A, Chow E, Zhang L, et al. Determining the incidence of pain flare following palliative radiotherapy for symptomatic bone metastases: results from three canadian cancer centers. Int J Radiat Oncol Biol Phys. 2009; 75(1): 193–197.
  8. Loi M, Klass ND, De Vries KC, et al. Pain flare, complexity and analgesia in bone oligometastases treated with stereotactic body radiation therapy. Eur J Cancer Care (Engl). 2018; 27(6): e12915.
  9. MacLeod K, Laird BJA, Carragher NO, et al. Predicting Response to Radiotherapy in Cancer-Induced Bone Pain: Cytokines as a Potential Biomarker? Clin Oncol (R Coll Radiol). 2020; 32(10): e203–e208.
  10. Lim FMY, Bobrowski A, Agarwal A, et al. Use of corticosteroids for pain control in cancer patients with bone metastases: a comprehensive literature review. Curr Opin Support Palliat Care. 2017; 11(2): 78–87.
  11. Niglas M, Raman S, Rodin D, et al. Should dexamethasone be standard in the prophylaxis of pain flare after palliative radiotherapy for bone metastases?-a debate. Ann Palliat Med. 2018; 7(2): 279–283.
  12. van der Linden YM, Westhoff PG, Stellato RK, et al. Dexamethasone for the Prevention of a Pain Flare After Palliative Radiation Therapy for Painful Bone Metastases: The Multicenter Double-Blind Placebo-Controlled 3-Armed Randomized Dutch DEXA Study. Int J Radiat Oncol Biol Phys. 2020; 108(3): 546–553.
  13. Yousef AAM, El-Mashad NM. Pre-emptive value of methylprednisolone intravenous infusion in patients with vertebral metastases. A double-blind randomized study. J Pain Symptom Manage. 2014; 48(5): 762–769.
  14. Chow E, Meyer RM, Ding K, et al. Dexamethasone in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a double-blind, randomised placebo-controlled, phase 3 trial. Lancet Oncol. 2015; 16(15): 1463–1472.
  15. Fagard RH, Staessen JA, Thijs L. Advantages and disadvantages of the meta-analysis approach. J Hypertens Suppl. 1996; 14(2): S9–12; discussion S13.
  16. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339: b2700.