McDonald Rachel, Chow Edward, Rowbottom Leigha, DeAngelis Carlo, Soliman Hany
Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
J Bone Oncol. 2014 Oct 30;3(3-4):84-9. doi: 10.1016/j.jbo.2014.10.001. eCollection 2014 Nov.
Pain flare is a temporary increase in pain and is a potential side effect of radiotherapy treatment. However, its incidence has been reported only in recent studies, and with great variability. A few studies have reported on the use of dexamethasone as a prophylactic agent in the prevention of pain flare. The objective of this study is to present a review of the available literature regarding the incidence of pain flare and use of dexamethasone as a preventative measure.
A literature search was conducted in PubMed using subject keywords including: "radiation therapy", "stereotactic radiation therapy", "bone metastases", "pain flare", and "dexamethasone". The search was limited to English only but not restricted to any time period. Additionally, a search was also conducted in the American Society for Therapeutic Radiology and Oncology (ASTRO) 2014 book of published abstracts. Inclusion criteria were primary studies published with full text and/or abstracts only. Letters to the editor were excluded.
A total of 11 studies were selected, two of which were abstracts published by ASTRO in 2014. Seven articles investigated pain flare and/or dexamethasone use for conventional external beam radiation therapy (EBRT) while the remaining four investigated stereotactic body radiation therapy (SBRT). Pain flare incidence ranged from 2 to 44% for EBRT and 10 to 68% in SBRT. The use of dexamethasone also showed to be effective in both the prophylaxis and treatment of pain flare.
Pain flare has been established as an acute toxicity of both EBRT and SBRT, although its incidence is widely variable due to differences in data collection. The use of dexamethasone in the prophylaxis of pain flare is efficacious. Future studies are required in order to both optimize the reporting of pain and the dexamethasone regimens in the prevention of pain flare.
疼痛加剧是疼痛的暂时增加，是放射治疗的潜在副作用。然而，其发生率仅在最近的研究中有所报道，且差异很大。一些研究报告了使用地塞米松作为预防疼痛加剧的药物。本研究的目的是对有关疼痛加剧发生率及使用地塞米松作为预防措施的现有文献进行综述。
在PubMed中使用主题关键词进行文献检索，关键词包括：“放射治疗”、“立体定向放射治疗”、“骨转移”、“疼痛加剧”和“地塞米松”。检索仅限于英文，但不限于任何时间段。此外，还在美国放射肿瘤学会（ASTRO）2014年发表的摘要集中进行了检索。纳入标准为仅发表全文和/或摘要的原发性研究。给编辑的信件被排除。
共选择了11项研究，其中两项是ASTRO在2014年发表的摘要。七篇文章研究了传统外照射放疗（EBRT）中疼痛加剧和/或地塞米松的使用，其余四篇研究了立体定向体部放疗（SBRT）。EBRT的疼痛加剧发生率为2%至44%，SBRT为10%至68%。地塞米松的使用在预防和治疗疼痛加剧方面也显示出有效性。
疼痛加剧已被确定为EBRT和SBRT的一种急性毒性，尽管由于数据收集的差异，其发生率差异很大。使用地塞米松预防疼痛加剧是有效的。未来需要进行研究，以优化疼痛报告和预防疼痛加剧的地塞米松治疗方案。
