Gomez-Iturriaga Alfonso, Cacicedo Jon, Navarro Arturo, Morillo Virginia, Willisch Patricia, Carvajal Claudia, Hortelano Eduardo, Lopez-Guerra Jose Luis, Illescas Ana, Casquero Francisco, Del Hoyo Olga, Ciervide Raquel, Irasarri Ana, Pijoan Jose Ignacio, Bilbao Pedro
Department of Radiation Oncology, Hospital Universitario Cruces/ Biocruces Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Spain.
Department of Radiation Oncology, Instituto Catalan de Oncología, Avinguda de la Gran via de l'Hospitalet, 199-203, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
BMC Palliat Care. 2015 Oct 1;14:48. doi: 10.1186/s12904-015-0045-8.
Palliative radiotherapy (RT) is an effective treatment for symptomatic bone metastases. Pain flare, a transient worsening of the bone pain after RT, has been described in previous reports with different incidence rates. The aim of the study was to prospectively evaluate the incidence of pain flare following RT for painful bone metastases and evaluate its effects on pain control and functionality of the patients.
Between June 2010 and June 2014, 204 patients were enrolled in this study and 135 patients with complete data were evaluable. Pain flare was defined as a 2- point increase in worst pain score as compared with baseline with no decrease in analgesic intake or a 25% increase in analgesic intake as compared with baseline with no decrease in worst pain score. All pain medications and worst pain scores were collected before, daily during, and for 10 days after RT. The Brief Pain Inventory (BPI) was filled out on the pretreatment and at the 4 weeks follow-up visit.
There were 90 men (66.7%) and 45 women (33.3%). Mean age was 66 years (SD 9.8). The most common primary cancer site was lung in 42 patients (31.1%), followed by prostate in 27 patients (20.0%). Forty-two patients (31.1%) patients received a single fraction of 8 Gy and 83 (61.5%) received 20 Gy in five fractions. The overall pain flare incidence across all centers was 51/135 (37.7%). The majority of pain flares occurred on days 1-5 (88.2%). The mean duration of the pain flare was 3 days (SD: 3). There were no significant relationships between the occurrence of pain flare and collected variables. All BPI items measured four weeks after end of RT showed significant improvement as compared with pretreatment scores (p < 0.001). No significant differences in BPI time trends were found between patients with and without flare pain.
Pain flare is a common event, occurring in nearly 40% of the patients that receive palliative RT for symptomatic bone metastases. This phenomenon is not a predictor for pain response.
姑息性放疗（RT）是治疗有症状骨转移的有效方法。疼痛加剧，即放疗后骨痛短暂加重，在既往报告中有不同的发生率描述。本研究的目的是前瞻性评估针对疼痛性骨转移进行放疗后疼痛加剧的发生率，并评估其对患者疼痛控制和功能的影响。
2010年6月至2014年6月期间，204例患者纳入本研究，135例有完整数据的患者可进行评估。疼痛加剧定义为与基线相比，最严重疼痛评分增加2分且镇痛药物摄入量未减少，或与基线相比，镇痛药物摄入量增加25%且最严重疼痛评分未降低。在放疗前、放疗期间每日以及放疗后10天收集所有止痛药物和最严重疼痛评分。在治疗前和随访4周时填写简明疼痛量表（BPI）。
男性90例（66.7%），女性45例（33.3%）。平均年龄66岁（标准差9.8）。最常见的原发癌部位是肺癌42例（31.1%），其次是前列腺癌27例（20.0%）。42例（31.1%）患者接受单次8 Gy照射，83例（61.5%）患者接受5次分割共20 Gy照射。所有中心的总体疼痛加剧发生率为51/135（37.7%）。大多数疼痛加剧发生在第1 - 5天（88.2%）。疼痛加剧的平均持续时间为3天（标准差：3）。疼痛加剧的发生与所收集变量之间无显著关系。放疗结束4周后测量的所有BPI项目与治疗前评分相比均有显著改善（p < 0.001）。有和没有疼痛加剧的患者在BPI时间趋势上没有显著差异。
疼痛加剧是常见事件，在接受姑息性放疗治疗有症状骨转移的患者中近40%会发生。这种现象不是疼痛反应的预测指标。
