title: Dexamethasone for the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a pilot study.
abstract: 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.
authors.affiliation: 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.
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
authors.affiliation: Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Loblaw
authors.affiliation: Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: Kristin
authors.initials: K
authors.lastname: Harris
authors.affiliation: Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: Meagan
authors.initials: M
authors.lastname: Doyle
authors.affiliation: Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: Philiz
authors.initials: P
authors.lastname: Goh
authors.affiliation: Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: Hannah
authors.initials: H
authors.lastname: Chiu
authors.affiliation: Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: Tony
authors.initials: T
authors.lastname: Panzarella
authors.affiliation: Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: May
authors.initials: M
authors.lastname: Tsao
authors.affiliation: Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Barnes
authors.affiliation: Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: Sinclair
authors.affiliation: Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: Macey
authors.initials: M
authors.lastname: Farhadian
authors.affiliation: Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: Cyril
authors.initials: C
authors.lastname: Danjoux
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone