Single-fraction RT to the femur was effective in the prevention of femoral fractures. The pain score was also decreased in our patient population. Further studies are needed to explore 8 Gy/1 fx against standard radiation as a more effective means of delivering therapeutic and convenient treatment in metastatic patients.
Tijana Skrepnik, MD, Lauren Eisenberg, BS, Hitendra Patel, MD, Krisha Howell, MD; Department of Radiation Oncology, Department of Hematology/Oncology, Banner/University of Arizona Hospitals; University of Arizona
INTRODUCTION: Femoral metastases pose a threat of fracture. A low Mirel bone score (MBS) of < 8 points predicts a fracture rate of ~4% with standard fractionation radiation therapy (RT) alone. A score of > 8 points indicates a risk of fracture of 15% or higher, suggesting a role for surgical stabilization in addition to standard RT. Little data exist confirming the efficacy of single-fraction RT for fracture prevention.
METHODS: We performed a retrospective review of femoral metastases treated to 8 Gy × one fraction (fx). Relevant images and pain scores were reviewed for bony stability and assigned an MBS. Surgical consultation/intervention, prospectively acquired pain scores/toxicity assessments, and in-field fracture rates as reported on follow-up imaging were assessed.
RESULTS: In reviewing 198 charts, 24 metastatic femoral lesions from nonmyelomatous primaries were identified. Median clinical and radiographic follow-up was 1 month and 3 months, with a median overall survival status postcompletion of therapy of 4.3 months (range: 0.3–31.9 mo). The highest fracture risk region (peritrochanteric) constituted 41.7% of lesions, followed by head/neck (33.3%), femoral shaft (20.8%), and epiphyseal (4%) locations. Median MBS was 8 (range: 6–12), and two-thirds of patients did not receive a surgical consult. There were three fractures prior to RT (one nondisplaced, one previously stabilized, and one impending). Four sites received surgical intervention with a median intervention time of 14 months before RT (range: 0.4–24 mo). All (100%) irradiated bony sites had no subsequent fractures. Median pretreatment and posttreatment pain scores were 7 and 0, respectively, with a median improvement of 6 points on the pain scale.
CONCLUSION: Single-fraction RT to the femur was effective in the prevention of femoral fractures. The pain score was also decreased in our patient population. Further studies are needed to explore 8 Gy/1 fx against standard radiation as a more effective means of delivering therapeutic and convenient treatment in metastatic patients.
Proceedings of the 98th Annual Meeting of the American Radium Society - americanradiumsociety.org
Frontline Chemo-Free Regimen Supported in HR+/HER2+ Breast Cancer Therapy
January 1st 2024Combining anastrozole with palbociclib, trastuzumab, and pertuzumab as a frontline therapy for hormone receptor–positive, HER2-positive breast cancer may avoid some of the toxicities associated with chemotherapy, says Amy Tiersten, MD.
Oncology On-The-Go Podcast: ASCO 2023 Recap
June 19th 2023Experts from University of California, Los Angeles Health and Mayo Clinic discuss key data presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting in the gynecologic and gastrointestinal cancer spaces and how they may impact patient care.