Department of Radiation Oncology, Juntendo University School of Medicine, Tokyo, Japan;
Department of Radiation Oncology, Juntendo University School of Medicine, Tokyo, Japan.
Anticancer Res. 2023 Feb;43(2):865-873. doi: 10.21873/anticanres.16229.
BACKGROUND/AIM: Low risk asymptomatic bone metastasis (LRABM) without gross osteolytic changes tends to be out of indication for radiotherapy. The aim of this study was to evaluate the time between the end of palliative radiotherapy of bone metastasis (BM) until the start of new pain, in patients with painful BM.
Patients with BM were prospectively assessed for location and strength of pain every month for one year after radiotherapy. The correlation of pain relapse at irradiated site, and pain onset outside the irradiated site was evaluated with sex, age, primary tumor, pathology of tumor, visceral metastases, baseline scores for Eastern Cooperative Oncology Group performance status (PS), and baseline verbal rating scale (VRS).
A hundred and thirty-two patients were included (79 males and 53 females). Median age was 66 years. Primary sites were lung (n=60), breast (n=17), colon (n=12), prostate (n=11), and others (n=33) (one patient had two primary sites). Median follow-up was 185 days. Pain relief was observed in 92 patients (86.0%). Out of them, pain progression was observed in 69.6%. Median time to pain progression was 75.5 days. Pain onset outside the irradiated site was observed in 57 patients (43.2%). Median time to pain onset was 109 days. Out of the 57 patients, 13 (22.8%) had LRABM which existed before the start of radiotherapy. There were 54 patients with LRABM in this study and because many patients had more than one LRABM, the total LRABM sites were 123. Out of them, pain onset was observed within one year after irradiation in 44 (36%) lesions. Median time to pain onset was 67 days, which was the shortest of the three: irradiated site, out of the irradiated site, and LRABM site. Risk factors for high probability of pain onset within one year in LRABM lesions were female sex (showing a trend in univariate analysis), and pelvic, skull and spine metastasis (significant in multivariate analysis).
Time to pain onsets in LRABM are relatively short, especially in female patients with pelvic, skull and spine metastasis. In these patients, prophylactic radiotherapy could be an option to consider.
背景/目的：无明显溶骨性变化的低风险无症状骨转移（LRABM）往往不符合放射治疗的适应证。本研究旨在评估骨转移（BM）姑息性放疗结束至出现新疼痛之间的时间，以及在出现疼痛性 BM 的患者中。
前瞻性评估 BM 患者在放疗后 1 年内每月疼痛的部位和强度。评估放射治疗部位疼痛复发与放射治疗部位以外疼痛发生的相关性，并与性别、年龄、原发肿瘤、肿瘤病理、内脏转移、东部合作肿瘤组绩效状态（PS）基线评分和基线口头评分量表（VRS）相关。
共纳入 132 例患者（79 例男性，53 例女性）。中位年龄为 66 岁。原发部位为肺（n=60）、乳腺（n=17）、结肠（n=12）、前列腺（n=11）和其他（n=33）（1 例患者有两个原发部位）。中位随访时间为 185 天。92 例患者（86.0%）观察到疼痛缓解。其中 69.6%观察到疼痛进展。疼痛进展的中位时间为 75.5 天。57 例患者（43.2%）观察到放射治疗部位以外的疼痛发作。疼痛发作的中位时间为 109 天。在这 57 例患者中，有 13 例（22.8%）存在 LRABM，且在放射治疗开始前即存在。在这项研究中，有 54 例患者存在 LRABM，由于许多患者有不止一处 LRABM，因此 LRABM 总部位为 123 处。其中，44 处（36%）在放射治疗后 1 年内出现疼痛发作。疼痛发作的中位时间为 67 天，在这三个部位（放射治疗部位、放射治疗部位以外、LRABM 部位）中最短。LRABM 病变一年内发生疼痛高概率的危险因素为女性（单因素分析显示有趋势）和骨盆、颅骨和脊柱转移（多因素分析有统计学意义）。
LRABM 疼痛发作时间相对较短，特别是在骨盆、颅骨和脊柱转移的女性患者中。对于这些患者，可以考虑预防性放疗。
