I just read an abstract about using half-body irradiation (HBI) to control pain and quality of life (QOL) issues in cancer patients with multiple bone metastases (mets). I had never heard of HBI and since advanced prostate cancer commonly progresses to create bone metastases, I thought that it would be a good topic to explore.
The specific abstract I read came from Acta Oncol. 2008 October 31:1-6 Epub ahead of print. The study, written by Berg RS, etal, evaluated the effect of HBI in a very small number (n=44) of general cancer survivors who had multiple bone mets. The actual study was performed in the Department of Oncology, Aalborg Hospital University, Aalborg, Denmark. In the study, 37 of the survivors received radiation to their lower torso and 7 received it to their upper body.
All the subjects filled out a questionnaire evaluating their pain perception. The questionnaire was completed at 2, 4, 8, 16 and 24 weeks post radiation treatment. Seventy-six (76%) of the survivors report pain relief and 8.8% reported complete pain relief. The most common side effects was grade 1-2 diarrhea (49%) and four out of seven survivors receiving upper body radiation also reported grade 1-2 pulmonary symptoms. There was no significant effect on “global” quality of life.
Kuban DA, at the Department of Radiation Oncology, Eastern Virginia Medical School, Norfolk, performed a study using 31 prostate cancer survivors who received a total of 35 half-body irradiation treatments. Thirteen (13) of the treatments consisted of 600 to 800 cGy. to the upper half and 22 treatments of 400 to 1,000 cGy. to the lower half of the body. They found that the treatment (HBI) was well tolerated. The majority of the survivors obtained subjective relief that was evidenced by their decreased use of narcotic analgesics or change to nonprescription medication. Median survival after half-body irradiation was 5 months. The palliative effects of the radiation was maintained until death in 82 % of the survivors receiving treatment to the upper torso and 67% treated to the lower half of the body.
So, what is HBI? It involves giving radiation to one-half of the body, or sometimes to both halves, as a treatment for dispersed bone metastases. Sessions are limited to a one-time session as opposed to multiple sessions over an extended time. We know radiation as a site specific, or a focused treatment, however radiation treatments done this way are closer to a systematic treatment.
Clearly, HBI can provide significant and lasting pain relief to men who are end stage and suffering from pain from bone metastases. I do not believe that HBI is generally used, but it should be discussed with your doctors.
(Acta Oncol. 2008 Oct 31:1-6. Epub ahead of print; Berg RS, Yilmaz MK, Høyer M, Keldsen N, Nielsen OS, Ewertz M.; PubMed Abstract PMID:18979285)
Kuban DA, Delbridge T, el-Mahdi AM, Schellhammer PF., J Urol. 1989 Mar;141(3):572-4. PMID: 2465419
P. Rubin et al. Cancer, Vol 55, p2210, 1985)
Joel T. Nowak, MA, MSW
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