The Effect of Systemic Steroids on the Incidence of Bone Pain Flare with Palliative Irradiation

Background: a significant number of patients who receive palliative irradiationfor painful bone metastases experience pain flare, defined as a distressing transientincrease in pain not immediately controlled by additional analgesics. this pain ispostulated to be due to edema at the onset of radiotherapy. this study aims to comparethe incidence of bone pain flare among patients who receive steroid prophylaxis to thosewith no prophylaxis treatment.methods: from june 2011 to june 2013, 147 eligible patients with painful bonemetastases entered into this phase 3 prospective study. we divided patients into twogroups. group a received 8 mg dexamethasone one hour prior to irradiation during thetreatment time and for three days afterwards. group b received no prophylaxistreatment. all patients received radiotherapy at a dose of 2000 gy/5 fractions. thedevelopment of flare was recorded in each group and several factors were examinedto determine the presence of an influence on this incidence.results: group a included 68 patients, 11 (16.2%) of whom developed bone painflare while group b comprised 79 patients, 30 (38%) with bone pain flare. these resultsindicated that steroid prophylaxis made a statistically significant difference in decreasingpain flare incidence (p=0.0033). no steroid related complications were reported by anyof the patients. none of the factors assessed showed a statistically significant effecton flare development (p > 0.05).conclusion: administration of 8 mg of dexamethasone an hour prior to irradiationfor the treatment period and three days afterwards is effective in significantly decreasingthe incidence of pain flare. dexamethasone is well tolerated and may be recommendedfor all adult patients who undergo palliative bone irradiation who have no contraindi-cation to this treatment. larger phase 3 randomized trials are needed to confirm thesefindings.