Prophylactic Dexamethasone on Pain Flare in Spine Metastasis Stereotactic Body Radiotherapy and Hypofractionated Radiotherapy

Objective To explore the incidence of pain flare (PF) in spine metastasis stereotactic body radiotherapy (SBRT) or hypofractionated radiotherapy (HF) and the prophylactical effect of dexamethasone.

Methods Sixty-five patients were treated with spine metastasis SBRT and randomly divided into control group (SBRT or HF, n=32) and treatment group (SBRT or HF and 4.5 mg dexamethasone, n=33). The brief pain inventory (BPI) was used to score the pain before, during and after treatment. PF was recorded and compared between two groups.

Results The incidence of PF was 24.6% in all patients (control group: 37.5%, treatment group: 12.1%, P=0.018). PF in both group occurred in d1-2, accounting for 62.5% in all PF (control group: 66.7%, treatment group: 50%, P=0.551). The incidences of PF in control group were 66.7% and 33.3% for three and ten fractions scheme, respectively (P=0.001). However, the incidences of PF in treatment group were 50% and 50% for three and ten fractions scheme, respectively (P=0.643).

Conclusion Oral dexamethasone has an excellent efficacy in prevention and treatment of PF in spine metastasis SBRT or HF, with significantly decreased incidence of PF. A phase Ⅲ clinical trial is required to finalize the optimal dose and schedule.