title: Treatment of Solitary Painful Osseous Metastases with Radiotherapy, Cryoablation or Combined Therapy: Propensity Matching Analysis in 175 Patients.
abstract: OBJECTIVE
  aim of this study was to identify outcomes in pain relief and quality of life in patients with a solitary painful osseous metastasis treated by radiotherapy, cryoablation or the combination using a propensity score matching study design.
  
  
  METHODS
  175 patients with painful bone metastases were included in the study. Twenty-five of them underwent a radiation course (20 Gy in five daily fractions) 15 days after the cryoablation. These subjects were retrospectively matched by propensity analysis with a group of subjects treated by radiotherapy (125 subjects) and with a group treated byCryoablation (25 subjects). The pain relief in terms of complete response, rate of subjects requiring analgesics after treatments and the changes in self-rated quality of life were measured. Informed consent was obtained from the subject and the study was approved by the local Ethical Committee.
  
  
  RESULTS
  An higher proportion of subjects treated by cryoablation (32%) or cryoablation followed by RT (72%;) experienced a complete response compared with patients treated by radiotherapy alone (11.2%). After Bonferroni correction strategy, the addition of radiotherapy to cryoablation significantly improved the rate of complete response compared with cryoablation alone (p = 0.011) and this paralleled with an improved self-rated quality of life. Seventeen subjects (13.6%) of patients in the radiotherapy group, 9 (36%) in the cryoablation group, and 19 (76)% in the cryoablation- radiotherapy group did not require narcotic medications.
  
  
  CONCLUSIONS
  The addition of radiotherapy to cryoablation favorably impacts on perceived pain, with a favorable toxicity profile. However, our data should be interpreted with caution and could serve as a framework around which to design future trials.
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Division of Radiation Oncology and Radiobiology, S. Salvatore Hospital, University of L'Aquila, Medical School, L'Aquila, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Di Staso
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Division of Radiation Oncology and Radiobiology, S. Salvatore Hospital, University of L'Aquila, Medical School, L'Aquila, Italy.
authors.forename: Giovanni Luca
authors.initials: GL
authors.lastname: Gravina
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, S. Salvatore Hospital, University of L'Aquila, Medical School, L'Aquila, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Zugaro
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Division of Radiation Oncology and Radiobiology, S. Salvatore Hospital, University of L'Aquila, Medical School, L'Aquila, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Bonfili
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, S. Salvatore Hospital, University of L'Aquila, Medical School, L'Aquila, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Gregori
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Division of Radiation Oncology and Radiobiology, S. Salvatore Hospital, University of L'Aquila, Medical School, L'Aquila, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Franzese
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Division of Radiation Oncology and Radiobiology, S. Salvatore Hospital, University of L'Aquila, Medical School, L'Aquila, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marampon
authors.affiliation: Service of Medical Physics, San Salvatore Hospital, L'Aquila, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vittorini
authors.affiliation: Service of Medical Physics, San Salvatore Hospital, L'Aquila, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Moro
authors.affiliation: Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tombolini
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Division of Radiation Oncology and Radiobiology, S. Salvatore Hospital, University of L'Aquila, Medical School, L'Aquila, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Di Cesare
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, S. Salvatore Hospital, University of L'Aquila, Medical School, L'Aquila, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Masciocchi
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D017679:Cryotherapy; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management; D012189:Retrospective Studies