Purpose: After radiation therapy for painful bone metastases, up to 44% of patients report a pain flare (PF). Our study compared 2 dose schedules of dexamethasone versus placebo to prevent PF... Show morePurpose: After radiation therapy for painful bone metastases, up to 44% of patients report a pain flare (PF). Our study compared 2 dose schedules of dexamethasone versus placebo to prevent PF.Methods and Materials: This double-blind, randomized, placebo-controlled trial allocated patients with painful bone metastases from solid tumors randomly to receive 8 mg dexamethasone before radiation therapy followed by 3 daily doses (group A), 8 mg dexamethasone followed by 3 doses of placebo (group B), or 4 doses of placebo (group C). Patients reported worst pain scores, study medication side effects, and opioid intake before treatment and thereafter daily for 14 days and on day 28. PF was defined as at least a 2-point increase on a 0 to 10 pain scale with no decrease in opioid intake or a 25% or greater increase in opioid intake with no decrease in pain score, followed by a return to baseline or lower. The primary analysis was by intention to treat with patients who had missing data classified as having a PF.Results: From January 2012 to April 2016, 295 patients were randomized. PF incidence was 38% for group A, 27% for group B, and 39% for group C (P = .07). Although patients in group B had the lowest PF incidence, a relatively high percentage did not return to baseline pain levels, indicating pain progression. The mean duration of PF was 2.1 days for group A, 4.5 days for group B, and 3.3 days for group C (P = .0567). Dexamethasone postponed PF occurrence; in group A 52% occurred on days 2 to 5 versus 73% in group B and 99% in group C (P = .02). Patients in group A reported lower mean pain scores on days 2 to 5 than those in group B or C (P < .001). Side effects were similar.Conclusions: There was insufficient evidence that dexamethasone reduced the incidence of radiation-induced PF. However, dexamethasone postponed the occurrence of PF and led to lower mean pain scores on days 2 to 5. (C) 2020 Elsevier Inc. All rights reserved. Show less
Strijbos, J.; Linden, Y.M. van der; Vos-Westerman, H.; Baardwijk, A. van; Dutch Platform Palliation 2019
Background and purposePalliative radiotherapy (RT) is one of the treatment options for bleeding tumours; a frequent symptom in patients with advanced cancer. The optimal RT schedule is however... Show moreBackground and purposePalliative radiotherapy (RT) is one of the treatment options for bleeding tumours; a frequent symptom in patients with advanced cancer. The optimal RT schedule is however unclear. This study explores the current pattern of practice of palliative RT for bleeding tumours in the Netherlands.Materials and methodsAn internet-based questionnaire, including respondent characteristics, factors influencing the choice of RT schedules and five patient case scenarios, was sent to all members of the Dutch Society for Radiation Oncology. Descriptive statistics were used to evaluate the results.ResultsThe response rate was 125/374 (34%); representing 20 out of 21 Dutch RT departments. Most reported influencing factors were performance status, prognosis, patients’ comfort and patients’ choice. Most preferred RT schedules were 1 × 8 Gy for hematemesis, 1 × 8 Gy and 5 × 4 Gy for haemoptysis, 5 × 4 Gy for haematuria, 5 × 5 Gy for rectal bleeding, 1 × 8 Gy, 5 × 4 Gy and 10-13 × 3 Gy for vaginal bleeding.ConclusionsThe current patterns of practice in the Netherlands for bleeding tumours varied considerably. Most often a single fraction is chosen (35% of all cases), followed by a five-fraction schedule (30% of all cases). The choice of an RT schedule is mainly influenced by patient related factors. Show less
Wink, K.C.J.; Lock, S.; Rossi, M.; Baardwijk, A. van; Belderbos, J.; Ruysscher, D. de; Troost, E.G.C. 2019
Background and purpose: The aim was to investigate the incidence of isolated regional failure following stereotactic ablative radiotherapy (SABR) and risk factors for recurrence.Materials and... Show moreBackground and purpose: The aim was to investigate the incidence of isolated regional failure following stereotactic ablative radiotherapy (SABR) and risk factors for recurrence.Materials and methods: Early stage non-small cell lung cancer (NSCLC) patients treated with SABR were included in this retrospective cohort study, with isolated regional recurrence (IRR) as primary endpoint, distant recurrence (DR) and overall survival (OS) as secondary endpoints. Survival analyses were performed using the cumulative incidence function (IRR and DR) or the Kaplan-Meier method (OS) and Cox proportional hazards modelling for univariate and multivariate analyses. The prognostic effect of contact between the tumour and the pleura was investigated using the CT scans used for SABR planning.Results: A total of 554 patients were included, of whom 494 could be analysed for IRR. The median follow-up for surviving patients was 48.1 months. Twenty-one patients developed an IRR (4%). The cumulative incidence of IRR and DR after 1-, 2-, and 5 years was 2%, 3%, 7% and 8%, 15% and 21%, respectively. Two year OS was 71%. The presence and type of pleural contact was not associated with any of the studied outcomes.Conclusion: The presence, type and length of pleural contact as surrogate for visceral pleural invasion were not predictive for outcome. Further studies focussing on risk factors for occult nodal involvement, (I) RR, distant metastases and mortality in early stage NSCLC are warranted for the development of risk adapted diagnostic, treatment and follow-up strategies as more younger, operable and fitter patients receive SABR. (C) 2018 Elsevier B.V. All rights reserved. Show less
Linden, Y. van der; Westhoff, P.; Stellato, R.; Kasperts, N.; Baardwijk, A. van; Vries, K. de; ... ; Graeff, A. de 2018
Stereotactic body radiotherapy (SBRT) is an alternative to surgery for patients with early stage non-small cell lung cancer (NSCLC) who are inoperable due to comorbid disease or who refuse surgery.... Show moreStereotactic body radiotherapy (SBRT) is an alternative to surgery for patients with early stage non-small cell lung cancer (NSCLC) who are inoperable due to comorbid disease or who refuse surgery. SBRT results in an excellent local control rate of more than 90%, which is comparable to surgery, while short and long-term overall toxicity is low. Surgically treated patients are often more extensively staged pre-operatively, e.g. with endobronchial ultrasound and/or mediastinoscopy, and typically undergo intra-operative lymph node dissection or sampling. Occult nodal metastases (ONM), detected by lymph node dissection, have been shown to increase the incidence of regional recurrence (RR) after surgery, which is associated with poor outcome. In patients undergoing SBRT, however, definite pathological nodal staging is lacking and so other ways to identify patients at high risk for ONM and RR are desirable.The aim of this systematic review is to summarize the incidence of, and risk factors for, RR after SBRT and compare these to those after surgery. The available evidence shows the incidence of RR after SBRT or surgery to be comparable, despite more elaborate pre- and intra-operative lymph node evaluation in surgical patients. However, the fact that this finding is based on mostly retrospective studies in which the majority of patients treated with SBRT were inoperable, needs to be taken into consideration. For now, there is no evidence that inoperable clinical stage I patients with no indication of pathological lymph nodes on PET/CT will benefit from more invasive lymph node staging prior to SBRT. (C) 2017 Elsevier Ltd. All rights reserved. Show less
Dennis, K.; Zhang, L.Y.; Lutz, S.; Linden, Y. van der; Baardwijk, A. van; Holt, T.; ... ; Chow, E. 2013
