Management of Painful Bone Metastases: Our Experience According to Scientific Evidence on Palliative Radiotherapy

1. ROSSELLA DI FRANCO¹,
2. SARA FALIVENE¹⇑,
3. VINCENZO RAVO²,
4. MASSIMO MAMMUCARI³,
5. ENNIO SARLI³,
6. STELLA BAFFINI⁴,
7. GIAMPAOLO DE PALMA²,
8. ALFONSINA PEPE⁵,
9. MARIANNA TRAETTINO¹,
10. MATTEO MUTO⁵,
11. SALVATORE CAPPABIANCA¹ and
12. PAOLO MUTO²

+ Author Affiliations

1. ¹Radiation Oncology, Second University of Naples, Naples, Italy
2. ²Radiation Oncology Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione “Giovanni Pascale” IRCCS, Naples, Italy
3. ³Primary Care, Local Health System RMF, Rome, Italy
4. ⁴Progetti Live Surgery P.L.S., Florence, Italy
5. ⁵Radiation Oncology Muto-Onlus Foundation of Naples, Casavatore, Naples, Italy

1. Correspondence to: Sara Falivene, MD, Radiation Oncology, Second University of Naples, Pza Miraglia, 80131 Naples, Italy. Tel: +39 0815903277, Fax: +39 0815903809, e-mail: sara.falivene@gmail.com

Abstract

Aim: Our aim was to evaluate retrospectively the role of the radiotherapy in the multi-disciplinary management of pain due to bone metastases. 

Patients and Methods: A total of 305 patients received radiotherapy with or without bisphosphonate and antalgic drugs. Tolerability and efficacy were evaluated using a Numerical Rating Scale, Pain Intensity Difference evaluation scale related to administration of the drug, a 5-point verbal scale of the patients' general impression. 

Results: We found differences in some patient subgroups: pain reduction was significantly more evident in patients treated with a single-fraction radiotherapy scheme. Overall, 68% of patients experienced an improvement in pain control using concomitant drugs during radiotherapy.

 Conclusion: Our study underlines the role of radiotherapy in the management of metastatic bone pain. The use of rapid-onset opioids to prevent predictable pain is a crucial step in managing radiotherapy. An interdisciplinary approach is recommended.