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Int J Radiat Oncol Biol Phys. 2014 Nov 15;90(4):870-6. doi: 10.1016/j.ijrobp.2014.07.037. Epub 2014 Sep 13.

Incidence and predictive factors of pain flare after spine stereotactic body radiation therapy: secondary analysis of phase 1/2 trials.

Author information

1
Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas.
2
Department of Symptom Research, University of Texas MD Anderson Cancer, Houston, Texas.
3
Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas; Department of Radiation Oncology, USC Norris Cancer Center, Los Angeles, California.
4
Department of Neurosurgery, University of Texas MD Anderson Cancer, Houston, Texas.
5
Department of Diagnostic Radiology, University of Texas MD Anderson Cancer, Houston, Texas.
6
Department of Radiation Physics, University of Texas MD Anderson Cancer, Houston, Texas.
7
Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer, Houston, Texas.
8
Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas. Electronic address: AJGhia@mdanderson.org.

Abstract

PURPOSE/OBJECTIVE(S):

To perform a secondary analysis of institutional prospective spine stereotactic body radiation therapy (SBRT) trials to investigate posttreatment acute pain flare.

METHODS AND MATERIALS:

Medical records for enrolled patients were reviewed. Study protocol included baseline and follow-up surveys with pain assessment by Brief Pain Inventory and documentation of pain medications. Patients were considered evaluable for pain flare if clinical note or follow-up survey was completed within 2 weeks of SBRT. Pain flare was defined as a clinical note indicating increased pain at the treated site or survey showing a 2-point increase in worst pain score, a 25% increase in analgesic intake, or the initiation of steroids. Binary logistic regression was used to determine predictive factors for pain flare occurrence.

RESULTS:

Of the 210 enrolled patients, 195 (93%) were evaluable for pain flare, including 172 (88%) clinically, 135 (69%) by survey, and 112 (57%) by both methods. Of evaluable patients, 61 (31%) had undergone prior surgery, 57 (29%) had received prior radiation, and 34 (17%) took steroids during treatment, mostly for prior conditions. Pain flare was observed in 44 patients (23%). Median time to pain flare was 5 days (range, 0-20 days) after the start of treatment. On multivariate analysis, the only independent factor associated with pain flare was the number of treatment fractions (odds ratio = 0.66, P=.004). Age, sex, performance status, spine location, number of treated vertebrae, prior radiation, prior surgery, primary tumor histology, baseline pain score, and steroid use were not significant.

CONCLUSIONS:

Acute pain flare after spine SBRT is a relatively common event, for which patients should be counseled. Additional study is needed to determine whether prophylactic or symptomatic intervention is preferred.

PMID:
25227497
DOI:
10.1016/j.ijrobp.2014.07.037
[Indexed for MEDLINE]

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