Effectiviteit van herbestraling bij patiënten met pijnlijke botmetastasen*

Objective

To determine the effectiveness of reirradiation of painful bone metastases.

Design

Systematic review and meta-analysis

Method

A free text search was performed to identify eligible studies using the MEDLINE, EMBASE and the Cochrane Collaboration library electronic databases. The following terms and their synonyms were used: ‘painful bone metastases’, ‘radiotherapy’ and ‘reirradiation’. After study selection and quality assessment, a pooled estimate was calculated for overall pain response for reirradiation of metastatic bone pain.

Results

Our literature search identified 707 titles of which seven studies entered the meta-analysis. Studies were mainly observational or consisted of subgroup analyses of trials. There was a substantial between-study heterogeneity, which means that studies are not directly comparable due to differences in study design for example. Of the 2,694 patients initially treated for metastatic bone pain, 527 (20%) patients were reirradiated. Overall, a pain response after reirradiation was achieved in 58% of patients (CI 0.49-0.67).

Conclusion

Reirradiation of painful bone metastases is effective in terms of pain relief for the small majority of patients; approximately 40% of patients do not benefit from reirradiation. Although the validity of results is limited, this meta-analysis provides a comprehensive overview and the most quantitative estimate of reirradiation effectiveness to date.

Conflict of interest: none declared. Financial support: none declared.