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Title: Pain Flare Is a Common Adverse Event in Steroid-Naïve Patients After Spine Stereotactic Body Radiation Therapy: A Prospective Clinical Trial

Abstract

Purpose: To determine the incidence of pain flare after spine stereotactic body radiation therapy (SBRT) in steroid-naïve patients and identify predictive factors. Methods and Materials: Forty-one patients were treated with spine SBRT between February 2010 and April 2012. All patients had their pain assessed at baseline, during, and for 10 days after SBRT using the Brief Pain Inventory. All pain medications were recorded daily and narcotics converted to an oral morphine equivalent dose. Pain flare was defined as a 2-point increase in worst pain score as compared with baseline with no decrease in analgesic intake, a 25% increase in analgesic intake as compared with baseline with no decrease in worst pain score, or if corticosteroids were initiated at any point during or after SBRT because of pain. Results: The median age and Karnofsky performance status were 57.5 years (range, 27-80 years) and 80 (range, 50-100), respectively. Eighteen patients were treated with 20-24 Gy in a single fraction, whereas 23 patients were treated with 24-35 Gy in 2-5 fractions. Pain flare was observed in 68.3% of patients (28 of 41), most commonly on day 1 after SBRT (29%, 8 of 28). Multivariate analysis identified a higher Karnofsky performance status (P=.02) andmore » cervical (P=.049) or lumbar (P=.02) locations as significant predictors of pain flare. In those rescued with dexamethasone, a significant decrease in pain scores over time was subsequently observed (P<.0001). Conclusions: Pain flare is a common adverse event after spine SBRT and occurs most commonly the day after treatment completion. Patients should be appropriately consented for this adverse event.« less

Authors:
 [1]; ; ; ; ; ;  [1];  [1]
  1. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada)
Publication Date:
OSTI Identifier:
22224521
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 86; Journal Issue: 4; Other Information: Copyright (c) 2013 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CLINICAL TRIALS; DEXAMETHASONE; DOSE EQUIVALENTS; MORPHINE; MULTIVARIATE ANALYSIS; PAIN; PATIENTS; RADIOTHERAPY; VERTEBRAE

Citation Formats

Chiang, Andrew, Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Zeng, Liang, Zhang, Liying, Lochray, Fiona, Korol, Renee, Loblaw, Andrew, Chow, Edward, Sahgal, Arjun, and Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON. Pain Flare Is a Common Adverse Event in Steroid-Naïve Patients After Spine Stereotactic Body Radiation Therapy: A Prospective Clinical Trial. United States: N. p., 2013. Web. doi:10.1016/J.IJROBP.2013.03.022.
Chiang, Andrew, Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Zeng, Liang, Zhang, Liying, Lochray, Fiona, Korol, Renee, Loblaw, Andrew, Chow, Edward, Sahgal, Arjun, & Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON. Pain Flare Is a Common Adverse Event in Steroid-Naïve Patients After Spine Stereotactic Body Radiation Therapy: A Prospective Clinical Trial. United States. https://doi.org/10.1016/J.IJROBP.2013.03.022
Chiang, Andrew, Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Zeng, Liang, Zhang, Liying, Lochray, Fiona, Korol, Renee, Loblaw, Andrew, Chow, Edward, Sahgal, Arjun, and Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON. 2013. "Pain Flare Is a Common Adverse Event in Steroid-Naïve Patients After Spine Stereotactic Body Radiation Therapy: A Prospective Clinical Trial". United States. https://doi.org/10.1016/J.IJROBP.2013.03.022.
@article{osti_22224521,
title = {Pain Flare Is a Common Adverse Event in Steroid-Naïve Patients After Spine Stereotactic Body Radiation Therapy: A Prospective Clinical Trial},
author = {Chiang, Andrew and Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON and Zeng, Liang and Zhang, Liying and Lochray, Fiona and Korol, Renee and Loblaw, Andrew and Chow, Edward and Sahgal, Arjun and Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON},
abstractNote = {Purpose: To determine the incidence of pain flare after spine stereotactic body radiation therapy (SBRT) in steroid-naïve patients and identify predictive factors. Methods and Materials: Forty-one patients were treated with spine SBRT between February 2010 and April 2012. All patients had their pain assessed at baseline, during, and for 10 days after SBRT using the Brief Pain Inventory. All pain medications were recorded daily and narcotics converted to an oral morphine equivalent dose. Pain flare was defined as a 2-point increase in worst pain score as compared with baseline with no decrease in analgesic intake, a 25% increase in analgesic intake as compared with baseline with no decrease in worst pain score, or if corticosteroids were initiated at any point during or after SBRT because of pain. Results: The median age and Karnofsky performance status were 57.5 years (range, 27-80 years) and 80 (range, 50-100), respectively. Eighteen patients were treated with 20-24 Gy in a single fraction, whereas 23 patients were treated with 24-35 Gy in 2-5 fractions. Pain flare was observed in 68.3% of patients (28 of 41), most commonly on day 1 after SBRT (29%, 8 of 28). Multivariate analysis identified a higher Karnofsky performance status (P=.02) and cervical (P=.049) or lumbar (P=.02) locations as significant predictors of pain flare. In those rescued with dexamethasone, a significant decrease in pain scores over time was subsequently observed (P<.0001). Conclusions: Pain flare is a common adverse event after spine SBRT and occurs most commonly the day after treatment completion. Patients should be appropriately consented for this adverse event.},
doi = {10.1016/J.IJROBP.2013.03.022},
url = {https://www.osti.gov/biblio/22224521}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 86,
place = {United States},
year = {Mon Jul 15 00:00:00 EDT 2013},
month = {Mon Jul 15 00:00:00 EDT 2013}
}