E Gallizia1, G Apicella1, T Cena2,3, M Di Genesio Pagliuca3, L Deantonio1,3, M Krengli4,5. 1. Radiotherapy, University Hospital "Maggiore della Carità", Novara, Italy. 2. Biostatistics and Clinical Epidemiology, University Hospital "Maggiore della Carità", Novara, Italy. 3. Department of Translational Medicine, Chair of Radiotherapy, University of "Piemonte Orientale", Via Solaroli, 17, 28100, Novara, Italy. 4. Radiotherapy, University Hospital "Maggiore della Carità", Novara, Italy. krengli@med.uniupo.it. 5. Department of Translational Medicine, Chair of Radiotherapy, University of "Piemonte Orientale", Via Solaroli, 17, 28100, Novara, Italy. krengli@med.uniupo.it.
Abstract
BACKGROUND: Vertebral metastases are often causing pain and spine instability. Radiotherapy is of significant benefit for painful spine metastases but the response can be very variable. The spine instability neoplastic score (SINS) is a recent classification system for diagnosis of spinal instability caused by vertebral metastases. We analysed the degree of pain relief, the need of drug therapy and the imaging features and the SINS before and after radiotherapy. In particular, we investigated the possible correlation of spine instability defined by pre-treatment SINS with pretreatment pain and with response to radiotherapy. MATERIAL/ METHODS: This study included 121 patients with spine metastases treated with palliative 3D conformal radiotherapy. Pain "at rest" and "breakthrough pain", need for drug therapy in terms of "anti-inflammatory", "weak opioid", "strong opioid", imaging studies and SINS were assessed before and after radiotherapy. Statistical analysis was performed by the correlation coefficient of Spearman and Kruskal-Wallis test. RESULTS: Pain relief after radiotherapy was observed in 50.4 and 57.8% of patients in terms of pain at rest and breakthrough pain, respectively. The correlation between pain before radiotherapy and SINS was not statistically significant for both pain at rest (p = 0.4) and breakthrough pain (p = 0.49). The correlation between pain response after radiotherapy and SINS was statistically significant for both pain at rest (p = 0.007) and breakthrough pain (p = 0.047). DISCUSSION/ CONCLUSION: The degree of instability, classified according to SINS, resulted to be predictive factor for pain response after radiotherapy. SINS might become a valid tool to identify those patients who can benefit the most from radiotherapy.
BACKGROUND:Vertebral metastases are often causing pain and spine instability. Radiotherapy is of significant benefit for painful spine metastases but the response can be very variable. The spine instability neoplastic score (SINS) is a recent classification system for diagnosis of spinal instability caused by vertebral metastases. We analysed the degree of pain relief, the need of drug therapy and the imaging features and the SINS before and after radiotherapy. In particular, we investigated the possible correlation of spine instability defined by pre-treatment SINS with pretreatment pain and with response to radiotherapy. MATERIAL/ METHODS: This study included 121 patients with spine metastases treated with palliative 3D conformal radiotherapy. Pain "at rest" and "breakthrough pain", need for drug therapy in terms of "anti-inflammatory", "weak opioid", "strong opioid", imaging studies and SINS were assessed before and after radiotherapy. Statistical analysis was performed by the correlation coefficient of Spearman and Kruskal-Wallis test. RESULTS:Pain relief after radiotherapy was observed in 50.4 and 57.8% of patients in terms of pain at rest and breakthrough pain, respectively. The correlation between pain before radiotherapy and SINS was not statistically significant for both pain at rest (p = 0.4) and breakthrough pain (p = 0.49). The correlation between pain response after radiotherapy and SINS was statistically significant for both pain at rest (p = 0.007) and breakthrough pain (p = 0.047). DISCUSSION/ CONCLUSION: The degree of instability, classified according to SINS, resulted to be predictive factor for pain response after radiotherapy. SINS might become a valid tool to identify those patients who can benefit the most from radiotherapy.
Authors: Daryl R Fourney; Evan M Frangou; Timothy C Ryken; Christian P Dipaola; Christopher I Shaffrey; Sigurd H Berven; Mark H Bilsky; James S Harrop; Michael G Fehlings; Stefano Boriani; Dean Chou; Meic H Schmidt; David W Polly; Roberto Biagini; Shane Burch; Mark B Dekutoski; Aruna Ganju; Peter C Gerszten; Ziya L Gokaslan; Michael W Groff; Norbert J Liebsch; Ehud Mendel; Scott H Okuno; Shreyaskumar Patel; Laurence D Rhines; Peter S Rose; Daniel M Sciubba; Narayan Sundaresan; Katsuro Tomita; Peter P Varga; Luiz R Vialle; Frank D Vrionis; Yoshiya Yamada; Charles G Fisher Journal: J Clin Oncol Date: 2011-06-27 Impact factor: 44.544
Authors: Charles G Fisher; Christian P DiPaola; Timothy C Ryken; Mark H Bilsky; Christopher I Shaffrey; Sigurd H Berven; James S Harrop; Michael G Fehlings; Stefano Boriani; Dean Chou; Meic H Schmidt; David W Polly; Roberto Biagini; Shane Burch; Mark B Dekutoski; Aruna Ganju; Peter C Gerszten; Ziya L Gokaslan; Michael W Groff; Norbert J Liebsch; Ehud Mendel; Scott H Okuno; Shreyaskumar Patel; Laurence D Rhines; Peter S Rose; Daniel M Sciubba; Narayan Sundaresan; Katsuro Tomita; Peter P Varga; Luiz R Vialle; Frank D Vrionis; Yoshiya Yamada; Daryl R Fourney Journal: Spine (Phila Pa 1976) Date: 2010-10-15 Impact factor: 3.468
Authors: Liang Zeng; Edward Chow; Liying Zhang; Shaelyn Culleton; Lori Holden; Florencia Jon; Luluel Khan; May Tsao; Elizabeth Barnes; Cyril Danjoux; Arjun Sahgal Journal: Support Care Cancer Date: 2011-04-08 Impact factor: 3.603
Authors: Merel Huisman; Joanne M van der Velden; Marco van Vulpen; Maurice A A J van den Bosch; Edward Chow; F Cumhur Öner; Albert Yee; Helena M Verkooijen; Jorrit-Jan Verlaan Journal: Spine J Date: 2014-04-04 Impact factor: 4.166
Authors: Ingmar Schlampp; Stefan Rieken; Daniel Habermehl; Thomas Bruckner; Robert Förster; Jürgen Debus; Harald Rief Journal: Strahlenther Onkol Date: 2014-04-01 Impact factor: 3.621
Authors: Julia S Onken; Lucius S Fekonja; Romy Wehowsky; Vanessa Hubertus; Peter Vajkoczy Journal: Clin Exp Metastasis Date: 2019-08-16 Impact factor: 5.150
Authors: Michael R Bond; Anne L Versteeg; Arjun Sahgal; Laurence D Rhines; Daniel M Sciubba; James M Schuster; Michael H Weber; Michael G Fehlings; Aron Lazary; Michelle J Clarke; Stefano Boriani; Chetan Bettegowda; Paul M Arnold; Ziya L Gokaslan; Charles G Fisher Journal: Global Spine J Date: 2019-03-31
Authors: Giuseppe Roberto Giammalva; Gianluca Ferini; Fabio Torregrossa; Lara Brunasso; Sofia Musso; Umberto Emanuele Benigno; Rosa Maria Gerardi; Lapo Bonosi; Roberta Costanzo; Federica Paolini; Paolo Palmisciano; Giuseppe Emmanuele Umana; Rina Di Bonaventura; Carmelo Lucio Sturiale; Domenico Gerardo Iacopino; Rosario Maugeri Journal: Life (Basel) Date: 2022-04-12