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Pain Relief after Stereotactic Radiotherapy of Pancreatic Adenocarcinoma: An Updated Systematic Review

Severe pain is frequent in patients with locally advanced pancreatic ductal adenocarcinoma (PDCA). Stereotactic body radiotherapy (SBRT) provides high local control rates in these patients. The aim of this review was to systematically analyze the available evidence on pain relief in patients with PD...

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Autores principales: Buwenge, Milly, Arcelli, Alessandra, Cellini, Francesco, Deodato, Francesco, Macchia, Gabriella, Cilla, Savino, Galietta, Erika, Strigari, Lidia, Malizia, Claudio, Cammelli, Silvia, Morganti, Alessio G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032429/
https://www.ncbi.nlm.nih.gov/pubmed/35448188
http://dx.doi.org/10.3390/curroncol29040214
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author Buwenge, Milly
Arcelli, Alessandra
Cellini, Francesco
Deodato, Francesco
Macchia, Gabriella
Cilla, Savino
Galietta, Erika
Strigari, Lidia
Malizia, Claudio
Cammelli, Silvia
Morganti, Alessio G.
author_facet Buwenge, Milly
Arcelli, Alessandra
Cellini, Francesco
Deodato, Francesco
Macchia, Gabriella
Cilla, Savino
Galietta, Erika
Strigari, Lidia
Malizia, Claudio
Cammelli, Silvia
Morganti, Alessio G.
author_sort Buwenge, Milly
collection PubMed
description Severe pain is frequent in patients with locally advanced pancreatic ductal adenocarcinoma (PDCA). Stereotactic body radiotherapy (SBRT) provides high local control rates in these patients. The aim of this review was to systematically analyze the available evidence on pain relief in patients with PDCA. We updated our previous systematic review through a search on PubMed of papers published from 1 January 2018 to 30 June 2021. Studies with full available text, published in English, and reporting pain relief after SBRT on PDCA were included in this analysis. Statistical analysis was carried out using the MEDCALC statistical software. All tests were two-sided. The I(2) statistic was used to quantify statistical heterogeneity (high heterogeneity level: >50%). Nineteen papers were included in this updated literature review. None of them specifically aimed at assessing pain and/or quality of life. The rate of analgesics reduction or suspension ranged between 40.0 and 100.0% (median: 60.3%) in six studies. The pooled rate was 71.5% (95% CI, 61.6–80.0%), with high heterogeneity between studies (Q(2) test: p < 0.0001; I(2) = 83.8%). The rate of complete response of pain after SBRT ranged between 30.0 and 81.3% (median: 48.4%) in three studies. The pooled rate was 51.9% (95% CI, 39.3–64.3%), with high heterogeneity (Q(2) test: p < 0.008; I(2) = 79.1%). The rate of partial plus complete pain response ranged between 44.4 and 100% (median: 78.6%) in nine studies. The pooled rate was 78.3% (95% CI, 71.0–84.5%), with high heterogeneity (Q(2) test: p < 0.0001; I(2) = 79.4%). A linear regression with sensitivity analysis showed significantly improved overall pain response as the EQD2α/β:10 increases (p: 0.005). Eight papers did not report any side effect during and after SBRT. In three studies only transient acute effects were recorded. The results of the included studies showed high heterogeneity. However, SBRT of PDCA resulted reasonably effective in producing pain relief in these patients. Further studies are needed to assess the impact of SBRT in this setting based on Patient-Reported Outcomes.
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spelling pubmed-90324292022-04-23 Pain Relief after Stereotactic Radiotherapy of Pancreatic Adenocarcinoma: An Updated Systematic Review Buwenge, Milly Arcelli, Alessandra Cellini, Francesco Deodato, Francesco Macchia, Gabriella Cilla, Savino Galietta, Erika Strigari, Lidia Malizia, Claudio Cammelli, Silvia Morganti, Alessio G. Curr Oncol Systematic Review Severe pain is frequent in patients with locally advanced pancreatic ductal adenocarcinoma (PDCA). Stereotactic body radiotherapy (SBRT) provides high local control rates in these patients. The aim of this review was to systematically analyze the available evidence on pain relief in patients with PDCA. We updated our previous systematic review through a search on PubMed of papers published from 1 January 2018 to 30 June 2021. Studies with full available text, published in English, and reporting pain relief after SBRT on PDCA were included in this analysis. Statistical analysis was carried out using the MEDCALC statistical software. All tests were two-sided. The I(2) statistic was used to quantify statistical heterogeneity (high heterogeneity level: >50%). Nineteen papers were included in this updated literature review. None of them specifically aimed at assessing pain and/or quality of life. The rate of analgesics reduction or suspension ranged between 40.0 and 100.0% (median: 60.3%) in six studies. The pooled rate was 71.5% (95% CI, 61.6–80.0%), with high heterogeneity between studies (Q(2) test: p < 0.0001; I(2) = 83.8%). The rate of complete response of pain after SBRT ranged between 30.0 and 81.3% (median: 48.4%) in three studies. The pooled rate was 51.9% (95% CI, 39.3–64.3%), with high heterogeneity (Q(2) test: p < 0.008; I(2) = 79.1%). The rate of partial plus complete pain response ranged between 44.4 and 100% (median: 78.6%) in nine studies. The pooled rate was 78.3% (95% CI, 71.0–84.5%), with high heterogeneity (Q(2) test: p < 0.0001; I(2) = 79.4%). A linear regression with sensitivity analysis showed significantly improved overall pain response as the EQD2α/β:10 increases (p: 0.005). Eight papers did not report any side effect during and after SBRT. In three studies only transient acute effects were recorded. The results of the included studies showed high heterogeneity. However, SBRT of PDCA resulted reasonably effective in producing pain relief in these patients. Further studies are needed to assess the impact of SBRT in this setting based on Patient-Reported Outcomes. MDPI 2022-04-11 /pmc/articles/PMC9032429/ /pubmed/35448188 http://dx.doi.org/10.3390/curroncol29040214 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Buwenge, Milly
Arcelli, Alessandra
Cellini, Francesco
Deodato, Francesco
Macchia, Gabriella
Cilla, Savino
Galietta, Erika
Strigari, Lidia
Malizia, Claudio
Cammelli, Silvia
Morganti, Alessio G.
Pain Relief after Stereotactic Radiotherapy of Pancreatic Adenocarcinoma: An Updated Systematic Review
title Pain Relief after Stereotactic Radiotherapy of Pancreatic Adenocarcinoma: An Updated Systematic Review
title_full Pain Relief after Stereotactic Radiotherapy of Pancreatic Adenocarcinoma: An Updated Systematic Review
title_fullStr Pain Relief after Stereotactic Radiotherapy of Pancreatic Adenocarcinoma: An Updated Systematic Review
title_full_unstemmed Pain Relief after Stereotactic Radiotherapy of Pancreatic Adenocarcinoma: An Updated Systematic Review
title_short Pain Relief after Stereotactic Radiotherapy of Pancreatic Adenocarcinoma: An Updated Systematic Review
title_sort pain relief after stereotactic radiotherapy of pancreatic adenocarcinoma: an updated systematic review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032429/
https://www.ncbi.nlm.nih.gov/pubmed/35448188
http://dx.doi.org/10.3390/curroncol29040214
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