The edition · Oncology
For painful bone metastases, SBRT matched conventional radiotherapy early and held pain control longer
A meta-analysis found more complete pain responses at six months and far fewer re-treatments with stereotactic radiotherapy. Also: iberdomide doubles MRD negativity in relapsed myeloma at a cost in infections, diet education for sleep during chemotherapy, and intrathecal pumps for refractory pain.
The edition in brief
A meta-analysis comparing stereotactic body radiotherapy with conventional external beam radiotherapy for painful bone metastases found similar pain relief and opioid use at three months, but SBRT gave more complete pain responses at six months (RR 1.43), less local progression at eight months (RR 0.36) and far less re-irradiation at 12 months (RR 0.13), with no difference in fractures, cord compression, toxicity or one-year survival. In EXCALIBER-RRMM, iberdomide with daratumumab and dexamethasone achieved MRD-negative complete response in 41% of patients with relapsed myeloma against 21% with daratumumab, bortezomib and dexamethasone, but with more grade 3–4 neutropenia (84% vs 11%), infections and pneumonia; progression-free survival is still awaited. A Chinese trial in 132 women with breast cancer on chemotherapy found 12 weeks of anti-inflammatory dietary education reduced sleep disturbance (49% vs 79%) and improved quality of life. A systematic review found intrathecal therapy via partially implanted devices reduced pain and opioid use in refractory cancer pain, with moderate-certainty evidence for pain and quality of life.
Iberdomide combination doubled MRD-negative response in relapsed myeloma, with more infections
Iberdomide-daratumumab-dexamethasone doubled MRD negativity in relapsed myeloma, but await survival data and plan for infections.
Anti-inflammatory diet education improved sleep during breast cancer chemotherapy
Consider anti-inflammatory dietary education for women with poor sleep during breast cancer chemotherapy.
Intrathecal therapy eased refractory cancer pain and cut opioid use
Refer patients with refractory cancer pain for intrathecal therapy assessment early, rather than escalating systemic opioids indefinitely.
Ask about expected survival before choosing a radiotherapy schedule for bone pain
Match the radiotherapy approach for bone metastases to the patient's expected survival.
SBRT for painful bone metastases: equal early relief, more durable control
For patients likely to live beyond six months, consider SBRT for painful bone metastases for more durable control.
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