Edward Chow1,2, Andrew Loblaw3, Kristin Harris3, Meagan Doyle3, Philiz Goh3, Hannah Chiu3, Tony Panzarella3, May Tsao3, Elizabeth A Barnes3, Emily Sinclair3, Macey Farhadian3, Cyril Danjoux3. 1. Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada. Edward.Chow@sunnybrook.ca. 2. Department of Radiation Oncology, Toronto Sunnybrook Regional Cancer Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5. Edward.Chow@sunnybrook.ca. 3. Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
Abstract
PURPOSE: To investigate the efficacy of dexamethasone as a prophylactic adjuvant analgesic to decrease pain flare and to assess its safety and tolerance of dexamethasone. MATERIALS AND METHODS: Patients treated with a single 8 Gy for bone metastases took 8 mg dexamethasone before the radiation treatment. The Brief Pain Inventory was administered at baseline and then daily for 10 days after radiation. Pain flare was defined as a two-point increase in the worst pain or a 25% increase in the analgesic intake when compared with the baseline. RESULTS: Thirty-three patients (23 males, 10 females) had complete follow-up data. Their median age was 73 years old. Ten patients had progressive worsening pain during the entire 10-day follow-up. A total of eight patients (24%; 95% CI, 10-39%) experienced pain flare during the 10-day follow-up. Two patients had a 1-day pain flare on day 3. Three patients had a 1-day pain flare on day 7. Three other patients had a prolonged pain flare: one had a 3-day pain flare on days 2-4, one had a 3-day pain flare on days 4-6, and the other, a 6-day pain flare on days 3-8. The half-life of dexamethasone is 36-54 h. Only one patient (3%) experienced pain flare in the first 2 days of follow-up with the action of dexamethasone. Dexamethasone was well tolerated. CONCLUSION: Dexamethasone might be effective in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases. Randomized trials are required to confirm the finding.
PURPOSE: To investigate the efficacy of dexamethasone as a prophylactic adjuvant analgesic to decrease pain flare and to assess its safety and tolerance of dexamethasone. MATERIALS AND METHODS: Patients treated with a single 8 Gy for bone metastases took 8 mg dexamethasone before the radiation treatment. The Brief Pain Inventory was administered at baseline and then daily for 10 days after radiation. Pain flare was defined as a two-point increase in the worst pain or a 25% increase in the analgesic intake when compared with the baseline. RESULTS: Thirty-three patients (23 males, 10 females) had complete follow-up data. Their median age was 73 years old. Ten patients had progressive worsening pain during the entire 10-day follow-up. A total of eight patients (24%; 95% CI, 10-39%) experienced pain flare during the 10-day follow-up. Two patients had a 1-day pain flare on day 3. Three patients had a 1-day pain flare on day 7. Three other patients had a prolonged pain flare: one had a 3-day pain flare on days 2-4, one had a 3-day pain flare on days 4-6, and the other, a 6-day pain flare on days 3-8. The half-life of dexamethasone is 36-54 h. Only one patient (3%) experienced pain flare in the first 2 days of follow-up with the action of dexamethasone. Dexamethasone was well tolerated. CONCLUSION: Dexamethasone might be effective in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases. Randomized trials are required to confirm the finding.
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