title: Palliative radiotherapy for painful bone metastases from solid tumors delivered with static ports of tomotherapy (TomoDirect): feasibility and clinical results.
abstract: OBJECTIVE
  To evaluate the feasibility and response to palliative radiotherapy delivered with static ports of tomotherapy--TomoDirect (TD) in patients affected with painful bone metastases from solid tumors.
  
  
  METHODS
  A prospective cohort of 130 patients (185 osseous lesions) was treated between 2010 and 2013 with TD. Three fractionation schedules were employed according to clinical decision-making (3 Gy × 10; 4 Gy × 5; 8 Gy × 1). Pain response was investigated at 2 weeks and 2 months (for evaluable patients). The Numeric Rating Scale (NRS-11) was used to assess pain. Response rates to radiotherapy were calculated following the criteria of the International Bone Metastases Consensus Group (IBMCG), accounting for the use of concomitant analgesics (response: complete or partial; non-response: stable pain, pain progression or "other"). Analgesic consumption was recalculated into the daily oral morphine-equivalent dose (OMED).
  
  
  RESULTS
  Most of the patients had 1-2 bone metastases (91); those with multiple lesions mostly had a metachronous presentation (60%). Synchronous lesions were mainly approached with multiple plans (63%). Most treatments employed 3-4 fields (77%). Treatment times ranged from 255 to 939 s depending on fractionation, fields, and target lesions number. At 2 weeks, the median self-reported worst pain decreased significantly as median oral morphine-equivalent dose regardless of fractionation used. The response rate according to the IBMCG-based response categories ranged from 45 to 55%. Pain relief duration seems (response at 2 months) slightly inferior with the single fraction approach, with a higher re-treatment rate. At 2 weeks, the median self-reported worst pain and OMED significantly decreased regardless of fractionation (response rate: 49-55%). Pain relief decreased at 2 months, especially for single fraction (higher re-treatment rate).
  
  
  CONCLUSIONS
  TD is a valid option to deliver palliative radiotherapy for painful bone metastases from solid tumors.
authors.affiliation: Department of Radiation Oncology, Tomotherapy Unit,1.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Franco
authors.forename: Fernanda
authors.initials: F
authors.lastname: Migliaccio
authors.forename: Veronica
authors.initials: V
authors.lastname: Angelini
authors.forename: Domenico
authors.initials: D
authors.lastname: Cante
authors.forename: Piera
authors.initials: P
authors.lastname: Sciacero
authors.forename: Andrea
authors.initials: A
authors.lastname: Peruzzo Cornetto
authors.forename: Valeria
authors.initials: V
authors.lastname: Casanova Borca
authors.forename: Michele
authors.initials: M
authors.lastname: Zeverino
authors.forename: Paolo
authors.initials: P
authors.lastname: Torielli
authors.forename: Cecilia
authors.initials: C
authors.lastname: Arrichiello
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Girelli
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: La Porta
authors.forename: Santi
authors.initials: S
authors.lastname: Tofani
authors.forename: Gianmauro
authors.initials: G
authors.lastname: Numico
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000556:secondary; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000473:pathology; D010146:Pain / Q000209:etiology / Q000532:radiotherapy*; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D016896:Treatment Outcome
keywords: Antalgic effect; IGRT; IMRT; Metastatic cancer; Osseous lesions; Pain relief; Painful bone metastases; Palliation; Palliative radiotherapy; Tomodirect; Tomotherapy