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Int J Radiat Oncol Biol Phys. 2012 Sep 1;84(1):8-14. doi: 10.1016/j.ijrobp.2011.10.080. Epub 2012 Jan 31.

Effectiveness of reirradiation for painful bone metastases: a systematic review and meta-analysis.

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1
Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands. m.huisman-7@umcutrecht.nl

Abstract

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.

PMID:
22300568
DOI:
10.1016/j.ijrobp.2011.10.080
[Indexed for MEDLINE]
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