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Poster Display session 1

1784 - Clinical predictors for analgesic response to radiotherapy in patients with painful bone metastases


28 Sep 2019


Poster Display session 1


End-of-Life Care

Tumour Site


Ragnhild Habberstad


Annals of Oncology (2019) 30 (suppl_5): v661-v666. 10.1093/annonc/mdz261


R. Habberstad1, T.C. Frøseth1, N. Aass2, E. Bjerkeset3, T. Abramova4, E. Garcia-Alonso5, M. Caputo6, R. Rossi7, J.W. Boland8, C. Brunelli9, J. Lund10, S. Kaasa11, P. Klepstad12

Author affiliations

  • 1 European Palliative Care Research Centre (prc), Department Of Clinical And Molecular Medicine, Norwegian University of Science and Technology and St. Olavs hospital, NO-7491 - Trondheim/NO
  • 2 European Palliative Care Research Centre (prc), Department Of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, 0423 - Oslo/NO
  • 3 European Palliative Care Research Centre (prc), Department Of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, 4956 - Nydalen/NO
  • 4 Dept. Oncology, Ålesund Hospital, Møre And Romsdal Hospital Trust, Ålesund, Norway, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund/NO
  • 5 Radiation Oncology Department, Arnau de Vilanova University Hospital, Lleida/ES
  • 6 Radiation Oncology 1, Palliative Care Pain Therapy And Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan/IT
  • 7 Palliative Care And Pain Therapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola/IT
  • 8 Palliative Care Research Centre, Hull York Medical School, Wolfson University of Hull, Hull/GB
  • 9 Palliative Care, Pain Therapy And Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano/IT
  • 10 Department Of Oncology And Department Of Health Sciences, Ålesund hospital and Faculty of Medicine and Health Sciences, Ålesund/NO
  • 11 Oncology, Oslo University Hospital, 424 - Oslo/NO
  • 12 Department Of Anesthesiology And Intensive Care Medicine, St Olavs hospital, Trondheim University Hospital, Trondheim/NO


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Abstract 1784


Radiationtherapy (RT) provide pain reduction in about 60% of patients with painful bone metastases. Studies have identified demographic and clinical characteristics to predict RT response, but no model is clinical useful. Tumor characteristics and inflammation can influence cancer induced bone pain, but the association with RT response are not studied. We test if tumor characteristics and the inflammation marker CRP improve prediction of RT response.


We included adult patients receiving RT for painful bone metastases in a multicenter, multinational longitudinal observational study. The primary endpoint was analgesic response within 8 weeks after RT defined according to current guidelines. Seventeen independent potential predictor variables assessed at baseline included patient demographics, RT administration, pain characteristics and treatment, cancer diagnosis, tumor characteristics, depression and inflammation (CRP). Multivariate logistic regression analysis with multiple imputation of missing data were applied to identify predictors of RT response. Results are reported as odds ratios (OR) and 95% confidence intervals (CI).


565 eligible patients were enrolled, 424 patients (75%) had complete data on the variables of interest and multiple imputation allowed the final regression models to be carried out on 513 patients (91%). 232 patients (41%, CI 37%-45%) responded to RT. Higher Karnofsky performance status (OR 1.45, CI 1.21-1.73), breast cancer (OR 2.61, CI 1.20-5.69) and prostate cancer (OR 2.64, CI 1.24-5.63) (compared to GI cancer), presence of soft tissue expansion (OR 1.78, CI 1.13-2.81) and higher maximum pain intensity at the radiated site (OR 1.1, CI 1.00-1.21) were significant predictors of positive RT response, while the use of steroids was a negative predictor (OR 0.62, CI 0.42-0.93). The discriminative ability of the model was moderate, with C-statistics 0.70.


This study supports previous findings that higher performance status, cancer diagnosis and higher baseline pain intensity predict analgesic RT response. The study presents new data showing that presence of soft tissue expansion predicts RT response and that CRP is not significantly associated with analgesic RT response.

Clinical trial identification

NCT02107664 (Date of registration April 8, 2014).

Editorial acknowledgement

Legal entity responsible for the study

Pål Klepstad.


The European Palliative Care Research Centre (PRC).


All authors have declared no conflicts of interest.

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