Dexamethasone for the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a pilot study.
OBJECTIVE
To investigate the efficacy of dexamethasone as a prophylactic adjuvant analgesic to decrease pain flare and to assess its safety and tolerance of dexamethasone.


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.


CONCLUSIONS
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.
Chow
Edward
E
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada. Edward.Chow@sunnybrook.ca.|Department of Radiation Oncology, Toronto Sunnybrook Regional Cancer Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5. Edward.Chow@sunnybrook.ca.
Loblaw
Andrew
A
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
Harris
Kristin
K
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
Doyle
Meagan
M
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
Goh
Philiz
P
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
Chiu
Hannah
H
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
Panzarella
Tony
T
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
Tsao
May
M
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
Barnes
Elizabeth A
EA
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
Sinclair
Emily
E
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
Farhadian
Macey
M
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
Danjoux
Cyril
C
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000556:secondary*; D017024:Chemotherapy, Adjuvant; D003907:Dexamethasone / Q000008:administration & dosage*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D010166:Palliative Care / Q000379:methods*; D010865:Pilot Projects; D011832:Radiation Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000517:prevention & control; D011877:Radionuclide Imaging; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone