Effects of Pamidronate Use on the Palliative Radiotherapy of Bone Metastases

William Levin, MD
OncoLink Assistant Editor
Ultima Vez Modificado: 24 de octubre del 2000

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Presenter: M.N. Yavux
Affiliation: Karadeniz University, Trabzone, Turkey


Background:

  • Between 15-70% of all cancer patients are found to have bone metastases over the course of their lifetime.

  • These lesions are frequently painful, cause a decrease in mobility, and negatively impact on the quality of life.

  • While radiation therapy can provide symptomatic relief for the majority of patients, more efficacious treatments are still needed.

  • Pamidronate is a osteoclast inhibitor used for the treatment of bone metastases.


Materials and Methods:

  • 50 patients with bone metastases were randomized to receive either PRT alone or PRT + pamidronate.

  • The most common primary cancer sites included: breast, lung, multiple myeloma, and prostate.

  • PRT consisted of 3Gy/day to a total dose of 30Gy

  • Planned PAM therapy was a 90mg infusion every 3 weeks for a total of 9 months.

  • Primary endpoints were pain and analgesia assessment, performance status, and quality of life score.

  • Endpoints were evaluated right before and just after PRT, and on follow-up exam, thereafter.


Results:

  • No significant differences were detected in the changes of pain and analgesia, performance status, quality of life, serum calcium, alkaline phosphatases, and mineral bone density between the two groups.

  • In PRT and PRT-PAM arms, median time to progression in the PRT field was 26 weeks and 68 weeks, respectively (log rank p = 0.05).

  • Median time to new bone metastases was 23 and 59 weeks, respectively (log rank p = 0.05).


Authors' Conclusions

  • The addition of PAM to PRT was of no significant advantage, in terms of quality of life, symptomatic palliation, and bone mineralization in the early post-RT period (first 5 months).

  • The addition of PAM may, however, be of benefit, regarding time to progression in the irradiated field and the occurrence of new bone metastases.


Clinical/Scientific Implications:

  • The effective treatment of painful bone metastases remains a significant challenge for the clinician.

  • New drug therapies should continue to be investigated in an attempt to maximize the efficacy of bone metastasis palliation.


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Use of Single-Fraction Radiation for Pain Found Rare in Elderly

Oct 9, 2013 - Although single-fraction radiotherapy has been shown to be effective for pain relief of bone metastases in patients with prostate cancer, only about 3 percent of elderly patients receive single-fraction compared with multiple-fraction radiotherapy, according to a research letter published in the Oct. 9 issue of the Journal of the American Medical Association.



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