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1.
Crit Rev Oncol Hematol ; 178: 103775, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35917886

RESUMO

PURPOSE: To compare the efficacy and safety of stereotactic body radiation therapy (SBRT) and conventional external beam radiation therapy (cEBRT) in patients with previously unirradiated painful bone metastases (BM). METHODS: We searched biomedical databases for eligible randomized controlled trials (RCTs). The outcomes of interest were pain response, local progression, overall survival (OS) and adverse events. We used established tools to assess the quality of the individual trials and certainty of the pooled evidence. We performed meta-analyses using random effects models. RESULTS: Six RCTs were identified. SBRT improved complete pain response rates at 3 months (OR, 3.38; 95% CI, 1.88-6.07; high certainty), reduced local progression rates (OR, 0.19; 95% CI, 0.06-0.62; high certainty) and increased pain flare rates. There were no differences for other outcomes. CONCLUSION: Among patients with previously unirradiated painful BM, SBRT significantly improved complete pain response rates at 3 months, delayed local progression and increased pain flare rates.


Assuntos
Neoplasias Ósseas , Radiocirurgia , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Humanos , Dor/etiologia , Dor/radioterapia , Radiocirurgia/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Exacerbação dos Sintomas
2.
J Pain Symptom Manage ; 64(4): 330-339, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35803553

RESUMO

CONTEXT: Inflammation is proposed to influence tumor response in radiotherapy (RT). Clinical studies to investigate the relationship between inflammatory markers and RT response is warranted to understand the variable RT efficacy in patients with painful bone metastases. OBJECTIVES: To evaluate the association between inflammatory markers and analgesic response to RT in patients with painful bone metastases. METHODS: Adult patients from 7 European study sites undergoing RT for painful bone metastases were included in this prospective and longitudinal analysis. The association between RT response and 17 inflammatory markers at baseline, as well as the association between RT response and the changes observed in inflammatory markers between baseline and three and eight weeks after RT, was analyzed with univariate regression analyses. Baseline analyses were adjusted for potential clinical predictors of RT response. RESULTS: None of the inflammatory markers were significantly associated with an upcoming RT response in the analysis of 448 patients with complete baseline data. In patients available for follow-up, the three-week change in TNF (P 0.017), IL-8 (P 0.028), IP-10 (P 0.032), eotaxin (P 0.043), G-CSF (P 0.033) and MCP-1 (P 0.002) were positively associated with RT response, while the three-week change in CRP (P 0.006) was negatively associated. CONCLUSION: Results from this study show an association between RT response and change in pro-inflammatory mediators and indicate that inflammation may be important to achieve an analgesic RT response in patients with painful bone metastases. None of the investigated inflammatory markers were found to be pre-treatment predictors of RT response.


Assuntos
Neoplasias Ósseas , Quimiocina CXCL10 , Adulto , Analgésicos/uso terapêutico , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Fator Estimulador de Colônias de Granulócitos , Humanos , Inflamação/radioterapia , Interleucina-8 , Dor/complicações , Dor/radioterapia , Cuidados Paliativos/métodos , Estudos Prospectivos
3.
Pain Res Manag ; 2022: 1119014, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35845981

RESUMO

The incidence of cancer is increasing worldwide on a yearly basis, with the number of patients with bone metastases also increasing annually. Events associated with bone metastases can seriously affect patient quality of life, through pain, hypercalcemia, bone marrow regeneration disorders, and spinal cord compression. In this nonrandomized controlled clinical trial study, we focused on the relationship between bone metastasis, pain, and cytokines before and after radiotherapy. We hypothesized that radiotherapy alters the cytokine profile of the local bone environment. Combined with the analgesic effects of radiotherapy, certain cytokines may be very sensitive to radiation. External radiation therapy is commonly used to treat cancer patients with bone metastases and can effectively relieve metastasis-related pain, although its underlying mechanisms have not been fully elucidated. For this case-control study, we recruited 30 cancer patients with bone metastasis and 30 healthy individuals. Peripheral venous blood from healthy individuals was collected. The clinical characteristics and peripheral venous blood were collected from patients one week before and one week after radiotherapy. The preradiotherapy and postradiotherapy pain scores, quality of life (QOL), and blood cytokine profiles of the patients to that of the controls were collected to identify pain-related cytokines. Finally, the pain score and the quality of life score improved significantly after radiotherapy. Moreover, the preradiotherapy and postradiotherapy blood cytokine profiles of the patients showed significant differences, indicating that the analgesic effect of radiotherapy against bone metastases is mediated via altered cytokine production. Furthermore, some cytokines were more sensitive to radiotherapy. The levels of MIP-1δ, MCP-2, TIMP-1, RANTES, IGFBP3, and TNF-α showed significant differences in the pairwise comparative analysis and may therefore mediate pain associated with bone metastasis.


Assuntos
Neoplasias Ósseas , Qualidade de Vida , Analgésicos/uso terapêutico , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Estudos de Casos e Controles , Citocinas , Humanos , Dor/tratamento farmacológico , Dor/etiologia , Dor/radioterapia , Cuidados Paliativos
4.
Lasers Med Sci ; 37(6): 2697-2706, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35695995

RESUMO

Discomfort and dull pain are known side effects of orthodontic treatment. Pain is expected to be reduced by near-infrared (NIR) lasers; however, the mechanism underlying effects of short-pulse NIR lasers in the oral and maxillofacial area remains unclear. This study aimed to examine the effects of high-frequency NIR diode laser irradiation on pain during experimental tooth movement (ETM) on 120 J. NIR laser with 910 nm wavelength, 45 W maximum output power, 300 mW average output power, and 200 ns pulse width (Lumix 2; (Lumix 2; Fisioline, Verduno CN, Italy) was used for the experiment. A nickel-titanium-closed coil was used to apply a 50-gf force between the maxillary left-side first molar and incisor in 7-week-old Sprague-Dawley rats (280-300 g) to induce ETM. We measured facial-grooming frequency and vacuous chewing movement (VCM) period between laser-irradiation and ETM groups. We performed immunofluorescent histochemistry analysis to quantify levels of Iba-1, astrocytes, and c-fos protein-like immunoreactivity (Fos-IR) in the trigeminal spinal nucleus caudalis (Vc). Compared with the ETM group, the laser irradiation group had significantly decreased facial-grooming frequency (P = 0.0036), VCM period (P = 0.043), Fos-IR (P = 0.0028), Iba-1 levels (P = 0.0069), and glial fibrillary acidic protein (GFAP) levels (P = 0.0071). High-frequency NIR diode laser irradiation appears to have significant analgesic effects on ETM-induced pain, which involve inhibiting neuronal activity, microglia, and astrocytes, and it inhibits c-fos, Iba-1, and GFAP expression, reducing ETM-induced pain in rats. High-frequency NIR diode laser application could be applied to reduce pain during orthodontic tooth movement.


Assuntos
Terapia a Laser , Manejo da Dor , Dor Processual , Técnicas de Movimentação Dentária , Animais , Incisivo , Raios Infravermelhos/uso terapêutico , Lasers Semicondutores/uso terapêutico , Ortodontia Corretiva/efeitos adversos , Ortodontia Corretiva/métodos , Dor/etiologia , Dor/radioterapia , Manejo da Dor/métodos , Dor Processual/etiologia , Dor Processual/radioterapia , Proteínas Proto-Oncogênicas c-fos , Ratos , Ratos Sprague-Dawley , Técnicas de Movimentação Dentária/efeitos adversos , Técnicas de Movimentação Dentária/métodos
5.
BMC Neurol ; 22(1): 226, 2022 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-35725414

RESUMO

BACKGROUND: Patients with bone metastasis often experience severe pain that is difficult to control and seriously affects quality of life. Radiotherapy is an effective way to relieve pain in these patients. Currently, there is no standard recommended range of radiotherapy targets for vertebral metastasis. The effect of radiotherapy on pain relief varies among patients, and some patients with metastases have serious side effects. METHODS: This study aims to verify whether reducing the radiotherapy range for vertebral metastases can achieve the same effect as whole vertebral radiotherapy while minimizing side effects. Sixty-six patients with pain caused by vertebral metastasis were randomly divided into two groups. The study group is receiving partial vertebrae body radiotherapy at the regions of abnormal signal, suspected invasion, and adjacent subclinical focus of vertebral metastasis, and the control group is receiving the same dose of radiotherapy on whole vertebrae body where metastasis occurred. After radiotherapy, along-term follow-up of patients will determine pain relief and side effects. DISCUSSION: The expected results of this study are that local irradiation of vertebral metastases can achieve a palliative effect of pain control not less than total vertebral irradiation with fewer side effects. TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Registry (No: ChiCTR1900023401 ).


Assuntos
Neoplasias da Coluna Vertebral , Ensaios Clínicos Fase II como Assunto , Humanos , Dor/etiologia , Dor/radioterapia , Manejo da Dor/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/secundário , Coluna Vertebral
6.
Photobiomodul Photomed Laser Surg ; 40(7): 463-471, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35766588

RESUMO

Objective: This study compared the efficacy of photobiomodulation therapy versus soft acrylic wafer for reduction of pain associated with orthodontic metal bracket removal. Background: It has been demonstrated that different methods of bracket removal are associated with different levels of pain. Photobiomodulation decreases the level of pain due to its biological effects. Methods: This split-mouth randomized clinical trial evaluated 28 orthodontic patients. The four quadrants in each patient were randomly assigned to four groups of diode laser (940 nm, 31.7 J/cm2 energy density, 1.7 cm2 spot size, 300 mW power, continuous-wave, contact mode) irradiated to the buccal and palatal surfaces of each tooth, soft acrylic wafer, laser in off mode (placebo), and no intervention (control). The severity of pain experienced by patients was assessed immediately after bracket removal from each tooth using a visual analog scale. Data were analyzed using the generalized estimating equation (α = 0.05). Results: The mean pain score in the soft acrylic wafer (p = 0.017), control (p < 0.001), and placebo (p < 0.001) groups was significantly higher compared with the laser group. Gender (p = 0.209), age (p = 0.095), and laterality (right/left quadrant; p = 0.383) had no significant effect on the pain score. The pain score in the mandible was significantly lower compared with the maxilla (p = 0.027). The first and second premolars had significantly lower pain scores (p < 0.05). Conclusions: Within the limitations of this study, photobiomodulation therapy and soft acrylic wafer can both decrease the pain associated with metal bracket removal, but laser is more effective.


Assuntos
Terapia com Luz de Baixa Intensidade , Braquetes Ortodônticos , Humanos , Terapia com Luz de Baixa Intensidade/métodos , Metais , Dor/etiologia , Dor/prevenção & controle , Dor/radioterapia , Medição da Dor/métodos , Técnicas de Movimentação Dentária
7.
Semin Oncol Nurs ; 38(2): 151279, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35491333

RESUMO

OBJECTIVES: We provide a review of external beam radiotherapy for pain associated with bone metastases, to summarize evidence associated with different radiotherapy fraction prescriptions, and outline the oncology nursing roles in a rapid-access palliative radiotherapy clinic. Additionally, we describe the clinical capacity contributed by a nurse practitioner working at full clinical scope. DATA SOURCES: Data derived from literary databases (PubMed, CINAHL); an ethics-approved, prospective data set; and clinical expertise. CONCLUSION: Nursing provides essential contributions in the treatment and holistic symptom management in patients undergoing radiation therapy for painful bone metastases. IMPLICATIONS FOR NURSING PRACTICE: The roles of nursing in radiation oncology have been poorly elucidated within the existing literature. This evaluation provided valuable insights into the contribution of oncology nursing roles in providing timely access for individuals with painful metastasis.


Assuntos
Neoplasias Ósseas , Radioterapia (Especialidade) , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Humanos , Enfermagem Oncológica , Dor/etiologia , Dor/radioterapia , Cuidados Paliativos , Estudos Prospectivos
8.
Lasers Med Sci ; 37(5): 2343-2352, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35404002

RESUMO

Pain is a common symptom of an illness. For decades, pain treatments such as non-steroidal anti-inflammatory drugs, opioids, and surgical nerve blocking have been widely used, but each method has its limitations. Photobiomodulation is a recently developed method for pain management, with light-emitting diodes (LEDs) being a more recent development used in pain management because of their low cost, low side effects, and high safety. Here, we reviewed the phototherapeutic effects of LEDs on different pain conditions. We also discussed possible physicochemical and neurobiological mechanisms underlying LED therapy, especially its effects on inflammatory pain.


Assuntos
Terapia com Luz de Baixa Intensidade , Humanos , Terapia com Luz de Baixa Intensidade/métodos , Dor/radioterapia , Manejo da Dor , Medição da Dor , Fototerapia/métodos
9.
Ann Palliat Med ; 11(6): 1900-1910, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35144390

RESUMO

BACKGROUND: Palliative radiation therapy (RT) for bone metastases (BMs) is a common practice. Wide variation exists in clinically used dose schema despite numerous studies demonstrating palliative equipoise between single and multifraction courses. We hypothesize that fraction scheme for palliating BMs for hepatocellular carcinoma (HCC) significantly affects how patients spend their remaining time. METHODS: Patients with osseous HCC metastases who received RT were identified from the National Cancer Database [2004-2013]. The percentage of remaining life spent receiving radiation therapy (PRLSRT) and the number of incomplete RT courses were calculated. Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate trends and predictors. RESULTS: A total of 1,331 patients met the inclusion criteria. Median overall survival (OS) was 3.3 months. Just 49 (3.7%) of patients received single fraction RT and 34% received >10 fractions. The mean and median PRLSRT were as follows: 1 fraction (8.9% and 3.0%), 2-5 fractions (32.9% and 24.3%), 6-10 fractions (27.2% and 15.9%), and >10 fractions (24.1% and 14.4%). Of the patients with PRLSRT >50%, 99.6% received multifraction RT. The proportion of incomplete RT courses increased as fraction size decreased from 17.6% with 4 Gy to 34% with 2 Gy. CONCLUSIONS: Single fraction palliative RT is vastly underutilized despite no additional palliative benefit with multifraction RT. PRLSRT significantly increased with multifraction RT. In the palliative treatment of painful BMs from HCC, single fraction treatment reduces time spent receiving radiation treatments and maximizes the number of patients who complete the prescribed treatment.


Assuntos
Neoplasias Ósseas , Carcinoma Hepatocelular , Neoplasias Hepáticas , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/radioterapia , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/radioterapia , Dor/radioterapia , Cuidados Paliativos
10.
Appl Radiat Isot ; 182: 110113, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35065360

RESUMO

Due to favorable physical properties of 141Ce radionuclide [Eßmax = 434.6 keV (70.5%) and 580.0 keV (29.5%), Eγ = 145.4 keV, and physical half-life = 32.5 day], a complex including this radionuclide could be a good candidate for palliative therapy of metastatic bone patients and an alternative to 89SrCl2 as a FDA-approved radiopharmaceutical. Because the bone marrow absorbed dose is a limiting factor in the palliative therapy of bone metastases, this study conducted to calculate the bone marrow absorbed dose of 141Ce-EDTMP complex and compare it with the 89SrCl2 using Monte Carlo simulation. In this study, the GATE Monte Carlo toolkit and two human bone models including vertebra and femur bones were used for simulations. The vertebra and femur bone marrow absorbed dose from 141Ce-EDTMP were 29.1 and 4.3 mGy/MBq, respectively. Moreover, the vertebra and femur bone marrow absorbed dose from 89SrCl2 were 109.2 and 16.3 mGy/MBq, respectively. Bone-to-bone marrow absorbed dose ratio in the vertebra for 141Ce-EDTMP and 89SrCl2 was 34.2 and 11.6, respectively, whereas, this ratio in the femur was 23.8 and 7.5, respectively. Owing to the high bone-to-bone marrow absorbed dose ratio and lower bone marrow absorbed dose than 89SrCl2, 141Ce-EDTMP could be a promising new complex for palliative therapy of patients with bone metastasis.


Assuntos
Medula Óssea , Neoplasias Ósseas/secundário , Manejo da Dor/métodos , Dor/radioterapia , Radiometria , Neoplasias Ósseas/complicações , Neoplasias Ósseas/radioterapia , Cério/química , Humanos , Método de Monte Carlo , Cuidados Paliativos/métodos , Dosímetros de Radiação , Dosagem Radioterapêutica
11.
Neurol Res ; 44(2): 91-96, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34315351

RESUMO

OBJECTIVES: To evaluate the effect of vertebroplasty (VP) alone or combined therapy of radiofrequency ablation (RFA) with vertebroplasty on pain relief with visual analog scale (VAS) and Oswestry Disability Index (ODI) scores in vertebral hemangiomas. METHODS: Forty-six patients with hemangiomas were evaluated retrospectively: 20 males and 26 females were included. In group 1 (n = 25) only VP was performed, while RFA+VP were performed in the same treatment session in group 2 (n = 21). Radiological diagnosis was performed with X-ray, CT-scan and MRI images in all patients. The intensity of pain was assessed with the VAS together with the assesment of life quality with the ODI. The assesments were performed before, at first day, at first month and 6 months after treatment. RESULTS: There was no significant difference between mean preprocedural VAS and ODI scores, but a significant decrease was seen in postprocedural VAS and ODI scores between group 1 and 2, when compared with the preprocedural values. Although lack of a statistically significant difference in long term results, mean VAS score was 3.7 for group 1, while it was 1.8 for group 2, and the mean ODI score was 38 for group 1, and 22.48 for group 2 at 6th month assesment. DISCUSSION: Although minimally invasive percutaneous techniques are indicated as other modalities are ineffective or contraindicated, combining RFA with vertebral augmentation provide prevention of mechanical loading pain, and prevention of somatic pain in patients with spinal hemangiomas.


Assuntos
Hemangioma/terapia , Avaliação de Resultados em Cuidados de Saúde , Dor , Ablação por Radiofrequência , Neoplasias da Coluna Vertebral/terapia , Vertebroplastia , Adulto , Terapia Combinada , Feminino , Hemangioma/complicações , Hemangioma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/radioterapia , Dor/cirurgia , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem
12.
J Dermatolog Treat ; 33(2): 1037-1041, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32700633

RESUMO

OBJECTIVES: Ability to predict which chronic itch patients will benefit from particular treatments is a challenge. Common features in itch and pain in respect to sensory elicitation, and mechanisms of processing including sensitization and inhibition at the peripheral and central levels, may serve to understand variability in treatment outcomes. As such this study aimed to explore whether phototherapy outcomes can be predicted by psychophysical parameters of pain and itch modulatory processing. METHODS: Prospective cohort study on chronic-itch patients (n = 44) assessed before 20 treatments of NB UVB. Level of itch and pain reduction following painful stimulation (reflecting the 'pain inhibits pain' phenomenon) used to assess the top-down modulation response efficacy. Magnitude of Conditioned Pain Modulation (CPM) for itch (CPM-itch) and for pain (CPM-pain) (reflecting inhibition) and magnitude of temporal summation (TS) of pain (reflecting ascending facilitation pathways) assessed to predict treatment effect. RESULTS: Higher improvement of itch symptoms following phototherapy was correlated with more efficient CPM-itch (r = 0.62, p < .001), but not magnitude of CPM-pain or level of temporal summation. DISCUSSION: Findings emphasize the role of descending inhibition pathways in determining phototherapy efficacy in chronic itch patients. Such an evaluation-based approach may contribute to better patient selection for phototherapy improving patients' disease outcomes.


Assuntos
Dor , Prurido , Humanos , Dor/etiologia , Dor/radioterapia , Fototerapia , Estudos Prospectivos , Prurido/etiologia , Prurido/radioterapia , Resultado do Tratamento
13.
Clin Transl Oncol ; 24(5): 846-853, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34807401

RESUMO

PURPOSE: This prospective study assessed the effects of low-dose radiotherapy in patients diagnosed with greater trochanteric pain syndrome (GTPS) with recurrent symptoms or refractory to previous conservative measures. METHODS: We evaluated a total of 155 patients (90.3% women, mean age 69 years). Most patients (n = 136) received 10 Gy (1 Gy/day/3 fractions per week on alternate days), but after recommendations of DEGRO guidelines published in 2015, the remaining 19 patients (12.2%) received 6 Gy (1 Gy/day/3 fractions per week on alternate days). RESULTS: At the pre-treatment visit, the mean (standard deviation, SD) visual analog scale (VAS) score was 8), which decreased to 5 (SD 2.2) after 1 month of the end of treatment and to 4 (SD 2.3) after 4 months. An objective symptom response with increased mobility, better sleep quality, and reduction of analgesic medication was found in 56% of patients at 1 month. In 129 patients (83.2%), there was a decrease of at least 1 point in the VAS score, and in 49 patients (29.0%), the VAS score was lower than 3. The mean length of follow-up was 45 months. The probability of maintaining the analgesic response estimated by the Kaplan-Meier method was 53% at 5 years. CONCLUSION: Low dose radiotherapy effectively improved pain in the trochanteric area in most patients with recurrent or refractory GTPS, allowing a reduction in the need for analgesic medications and, more, importantly, better functioning and mobility. Further randomized studies in selected populations of GTPS are needed to define the treatment position of low-dose radiotherapy in this clinical setting.


Assuntos
Bursite , Idoso , Bursite/diagnóstico , Bursite/terapia , Feminino , Fêmur , Humanos , Masculino , Dor/etiologia , Dor/radioterapia , Medição da Dor , Estudos Prospectivos
14.
Strahlenther Onkol ; 198(4): 370-377, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34724085

RESUMO

PURPOSE: Randomized comparison of the effect of radiotherapy on painful osteoarthritis (OA) applying a standard-dose vs. a very-low-dose regime PATIENTS AND METHODS: Patients with OA of the hand and knee joints were included. Further inclusion criteria: symptoms for more than 3 months, favorable general health status, age above 40 years. Patients with prior local radiotherapy, trauma, rheumatoid arthritis, or vascular diseases were excluded. After randomization (every joint was randomized separately), the following protocols were applied: standard arm: total dose 3.0 Gy, single fractions of 0.5 Gy twice weekly; experimental arm: total dose 0.3 Gy, single fractions of 0.05 Gy twice weekly. The dosage was not known to the patients. The patients were examined 3 and 12 months after radiotherapy. Scores like VAS (visual analogue scale), KOOS-SF (the knee injugy and osteoarthritis outcome score), SF-SACRAH (short form score for the assessment and quantification of chronic rheumatic affections of the hands), and SF-12 (short form 12) were used. RESULTS: A total of 64 knees and 172 hands were randomized. 3.0 Gy was applied to 87 hands and 34 knees, 0.3 Gy was given to 85 hands and 30 knees. After 3 months, we observed good pain relief after 3 Gy and after 0.3 Gy, there was no statistically significant difference. Side effects were not recorded. The trial was closed prematurely due to slow recruitment. CONCLUSION: We found favorable pain relief and a limited response in the functional and quality of life scores in both arms. The effect of low doses such as 0.3 Gy on pain is widely unknown. Further trials are necessary to compare a conventional dose to placebo and to further explore the effect of low doses on inflammatory disorders.


Assuntos
Osteoartrite do Joelho , Osteoartrite , Adulto , Seguimentos , Humanos , Osteoartrite/radioterapia , Osteoartrite do Joelho/radioterapia , Dor/radioterapia , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
16.
Semin Nucl Med ; 52(2): 178-190, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34895886

RESUMO

Amongst cancer patients, bone pain due to skeletal metastases is a major cause of morbidity. A number of beta-emitting radiopharmaceuticals have been used to provide internal radiotherapy of bone metastases and provide palliative pain relief. In this article we describe the different physical characteristics of the various beta emitting radionuclides which have been used in this clinical setting and the potential impact of differences in dose-rate on radiobiological outcomes. A detailed review of the biodistribution of these treatments, based on both in-vivo clinical investigations and post mortem autoradiography assessments is provided. These treatments result in physiological delivery of radiation doses to the target disease as well as to critical healthy organs. Particular attention is paid to the radiation doses received by normal bone tissue, bone marrow as well as metastatic bone disease. The underlying models of radiation transport within bone and bone marrow are reviewed alongside the practical steps that must be taken to acquire and analyse the information require for clinical dosimetry assessments. The role of whole body measurements, blood and faecal assays as well as both planar and tomographic gamma camera imaging are considered. In addition we review the rationale for allocating measured bone uptake between trabecular and cortical bone tissue. The difference between bone volume and bone surface seeking radiopharmaceuticals are also discussed. This review also extends to the development of preclinical models of bone metastases which may inform future dosimetric calculations. Finally, we also present a comprehensive review of the dosimetry of the established treatments 89Strontium-chloride; 32Phosphorus; 188Rhenium-hydroxyethylidine disphosphonate; 186Rhenium-1,1-hydroxyethylidene disphosphonate (186Re-HEDP); 153Samarium-ethylenediaminetetramethylene phosphonate; as well as the emerging treatments 188Rhenium-zoledronic acid; 188Rhenium-ibedronat; 177Lutetium-zoledronic acid; and 177Lutetium ethylenediaminetetramethylene phosphonate. This review highlights not only the inter treatment differences in the radiation absorbed doses delivered to metastatic disease by different radiopharmaceuticals but also the intra treatment differences which result in a large range of observed doses between patients.


Assuntos
Neoplasias Ósseas , Rênio , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/radioterapia , Osso e Ossos , Humanos , Lutécio , Dor/tratamento farmacológico , Dor/etiologia , Dor/radioterapia , Compostos Radiofarmacêuticos/uso terapêutico , Rênio/uso terapêutico , Distribuição Tecidual , Ácido Zoledrônico
17.
Med Sci (Basel) ; 9(4)2021 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-34842775

RESUMO

Background: Retrospective studies have described the effectiveness of low-dose radiotherapy (LD-EBRT) in painful arthrosis of small finger joints, but two recent prospective studies have yielded ambiguous results. To generate accurate data for the planning of a trial, we conducted a prospective, monocentric, observational study to describe the effects of LD-EBRT as precisely as possible. Methods: Twenty-five consecutive patients with symptomatic trapeziometacarpal (TMC) arthrosis were irradiated with 6 × 0.5 Gy. Before, 3, and 12 months after LD-EBRT, we assessed subjective endpoints (modified "von-Pannewitz score", 10-point visual analogue scale (VAS), "patient-rated wrist evaluation" (PRWE)), and objective measurements ("active range of motion" (AROM), Kapandji index, grip strength, pinch grip). Results: At 3/12 months, 80%/57% reported partial and 4%/18% complete remission according to the "von-Pannewitz" score. VAS "overall pain" significantly decreased from a median of seven (IQR 4) at baseline to three (IQR 6; p = 0.046) and to two (IQR 2; p = 0.013). Similar results were obtained for VAS "pain during exercise", VAS "pain during daytime", and VAS "function". "PRWE overall score" was reduced from 0.5 at baseline (SD 0.19) to 0.36 (SD 0.24, p = 0.05) and to 0.27 (SD 0.18, p = 0.0009). We found no improvements of the objective endpoints (AROM, Kapandji, grip strength) except for flexion, which increased from 64° (SD 12°) at baseline to 73° (SD 9.7°, p = 0.046) at 12 months. Conclusions: We recommend the PRWE score as a useful endpoint for further studies for this indication. To prove a 15% superiority over sham irradiation, we calculated that 750 patients need to be prospectively randomized.


Assuntos
Articulações Carpometacarpais , Osteoartrite , Humanos , Osteoartrite/radioterapia , Dor/radioterapia , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Polegar
18.
Praxis (Bern 1994) ; 110(15): 892-896, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34814712

RESUMO

Palliative Radiotherapy - An Important Tool in the Event Of Painful Bone Metastases Abstract. Many cancer patients suffer from metastases at an advanced stage, especially bone metastases, which are the third most frequent site of metastases and often occur in prostate, breast and lung carcinomas. Potential consequences are pain, pathological fractures and myelon compression with loss of function. Often there is a rapid reduction in the quality of life of the already burdened patients. Treatment is performed in an interdisciplinary setting with oncologists, radiation oncologists, palliative care and pain physicians as well as surgeons. Local radiotherapy is an established treatment option in order to achieve rapid, uncomplicated symptom control with few side effects and an improvement in the quality of life. Analgesic radiotherapy for bone metastases has been shown to have a response rate of up to 60-80 %.


Assuntos
Neoplasias Ósseas , Cuidados Paliativos , Analgésicos , Neoplasias Ósseas/radioterapia , Humanos , Masculino , Dor/etiologia , Dor/radioterapia , Qualidade de Vida
19.
Front Immunol ; 12: 740742, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34712229

RESUMO

The treatment of chronic inflammatory and degenerative diseases by low dose radiation therapy (LDRT) is promising especially for patients who were refractory for classical therapies. LDRT aims to reduce pain of patients and to increase their mobility. Although LDRT has been applied since the late 19th century, the immunological mechanisms remain elusive. Within the prospective IMMO-LDRT01 trial (NCT02653079) the effects of LDRT on the peripheral blood immune status, as well as on pain and life quality of patients have been analyzed. Blood is taken before and after every serial irradiation with a single dose per fraction of 0.5Gy, as well as during follow-up appointments in order to determine a detailed longitudinal immune status by multicolor flow cytometry. Here, we report the results of an interim analysis of 125 patients, representing half the number of patients to be recruited. LDRT significantly improved patients' pain levels and induced distinct systemic immune modulations. While the total number of leukocytes remained unchanged in the peripheral blood, LDRT induced a slight reduction of eosinophils, basophils and plasmacytoid dendritic cells and an increase of B cells. Furthermore, activated immune cells were decreased following LDRT. Especially cells of the monocytic lineage correlated to LDRT-induced improvements of clinical symptoms, qualifying these immune cells as predictive biomarkers for the therapeutic success. We conclude that LDRT improves pain of the patients by inducing systemic immune modulations and that immune biomarkers could be defined for prediction by improved patient stratification in the future.


Assuntos
Subpopulações de Linfócitos B/imunologia , Eosinófilos/imunologia , Leucócitos Mononucleares/patologia , Monócitos/imunologia , Osteoartrite/radioterapia , Dor/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Contagem de Células , Feminino , Seguimentos , Humanos , Imunomodulação , Leucócitos Mononucleares/efeitos da radiação , Masculino , Pessoa de Meia-Idade , Osteoartrite/imunologia , Radioterapia
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