title: Radiotherapy of painful vertebral hemangiomas: the single center retrospective analysis of 137 cases.
abstract: OBJECTIVE
  An evaluation of dose-response relationship and an attempt to define predictive factors.
  
  
  METHODS
  A total of 137 cases of painful vertebral hemangioma irradiations (101 patients). Fraction dose (fd) varied from 2 to 15 Gy (123 fractionated and 14 radiosurgical treatments), and total dose (TD) from 8 to 30 Gy (111 cases irradiated with fd of 2 GY to TD of 24 Gy). We evaluated pain relief, changes in analgesic requirements, and reossification.
  
  
  RESULTS
  Means of pain relief 1, 6, 12, and 18 months after radiotherapy (defined as a decrease of primary pain level expressed in percent) were 60.5%, 65.4%, 68.3%, and 78.4%, respectively. Proportion of patients with no need for analgesics and patients using tramadol were 39%, 40%, 44%, 57%, and 20%, 17%, 22%, and 11% in these times. The proportion of patients experiencing complete/partial pain relief changed from 36/48% 1 month, to 64/22% 1.5 years after radiotherapy. No impact of radiotherapy on reossification was found. The positive impact of fd and TD increase for analgesics uptake reduction and pain relief was found. An increase of the fd by 1 Gy results in 27% chance of analgesics uptake reduction and 3.8% reduction of pain, whereas 14% analgesics uptake reduction and 2.2% of pain reduction in case of the TD. The predictive factors improving results were found: female gender, older age, better performance states (the chance of the lower analgesic treatment decreases over 2.5 times in comparison to the higher Zubrod degree), bigger Hb concentration, shorter symptoms duration and lower analgesics uptake before radiotherapy.
  
  
  CONCLUSIONS
  The obtained data support the efficacy of radiotherapy in improving pain secondary to vertebral hemangioma, with the degree of pain amelioration being related to increasing fd and TD. The positive predictive factors were defined: female gender, older age, better performance status, increased Hb concentration, shorter symptoms duration, and lower analgesics uptake before radiotherapy.
authors.affiliation: Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland. leszek@io.gliwice.pl
authors.forename: Leszek
authors.initials: L
authors.lastname: Miszczyk
authors.forename: Andrzej
authors.initials: A
authors.lastname: Tukiendorf
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006391:Hemangioma / Q000150:complications / Q000532:radiotherapy*; D006441:Hemoglobin A / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy*; D010012:Osteogenesis / Q000528:radiation effects; D012720:Severity of Illness Index; D012737:Sex Factors; D013122:Spinal Diseases / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy*; D013125:Spinal Neoplasms / Q000150:complications / Q000532:radiotherapy*; D013131:Spine / Q000502:physiology / Q000528:radiation effects; D014147:Tramadol / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol; D006441:Hemoglobin A