Two Abstracts Explore Treating Painful Bone Metastases

Bone metastases can cause pain in patients with cancer, and 2 abstracts presented at the 2019 American Society of Clinical Oncology Annual Meeting evaluated treating this pain.

In the first study, the researchers analyzed the efficacy of using the OsteoCool Radiofrequency Ablation (RFA) system to treat patients with painful bone metastases.¹

A total of 37 patients at 8 US centers were enrolled between October 2017 and August 2018 and underwent RFA. The patients had no more than 2 painful target sites involving the thoracolumbar spine, pelvis, and/or sacrum. The worst pain was measured at ≥4/10 by the Brief Pain Inventory (BPI).

The patients were evaluated prior to RFA, at discharge, and then 3 days, 1 week, and 1, 3, 6, and 12 months after discharge. At baseline, the mean worst pain measured by BPI was 8.6. The most common primary cancers among the patients were breast (32%) and lung (24%).

At 1 week after treatment, 74% (25/34) of patients presenting at the visit reported a clinically significant change of ≥2 points in worst pain from baseline. Of the 14 patients presenting at the 3-month visit, 13 (93%) reported a clinically significant change. The same proportion of patients at the 3-month visit did not undergo radiation therapy at the targeted site(s) between baseline and the 3-month visit.

There were 11 deaths, but they were all attributed to the underlying cancer and were deemed not to be related to the RFA treatment.

“The preliminary results of the OPuS One study show rapid pain improvement at 1 week and sustained long-term relief through 3 months in patients with metastatic bone disease,” the authors concluded.

The second study analyzed the use of single-fraction radiotherapy (SFRT) in Australia.² It included 10,351 patients who had received a total of 15,668 courses of radiotherapy for bone metastases.

Overall, SFRT accounted for 18% of the courses. Evaluating the use of SFRT over time showed that there had been no significant change, with SFRT accounting for 18% in 2012, as well. In 2017, it accounted for 20% of radiotherapy courses.

The researchers found that older patients were more likely to have SFRT versus multifraction radiotherapy (MFRT), as well as patients who had lung cancer and prostate cancer. Patients in major cities were less likely to receive SFRT, as were patients being treated for metastases on the spine. Private institutions were also less likely to treat with SFRT compared with public institutions.

“There is large variation in SFRT use depending on patient, tumour, geographical, and institutional factors,” the authors concluded. “Further work is needed to increase uptake, and reduce unwarranted variation, in SFRT use.”

References

1. Bagla S, Levy J, Hopkins T, OPuS One Study Investigators. Effect on pain outcomes in patients treated for painful bone metastases with bipolar RFA: The OPuS One study. Presented at: 2019 American Society of Clinical Oncology Annual Meeting; May 31-June 4, 2019; Chicago, IL. Abstract: 11605.

2. Ong WL, Foroudi F, Millar JL. Australian population-based study of single- versus multi-fraction palliative radiotherapy for bone metastases. Presented at: 2019 American Society of Clinical Oncology Annual Meeting; May 31-June 4, 2019; Chicago, IL. Abstract: 6568.