Severe pain caused by metastases in the spine is common in cancer and is difficult to control. A study developed at the USZ has now shown that higher-dose precision radiation is more effective in fighting pain and can be used without damaging the spinal cord.
Around a third of patients with metastatic cancer have bone involvement, with the spine most frequently affected. These spinal metastases are often associated with severe restrictions in quality of life, particularly due to pain.
Previously used radiation often only has a short-term effect
Medication and local radiation of the tumors are used to alleviate the pain. Pain relief can be achieved in up to 60 percent of patients. In order to avoid damaging the radiation-sensitive spinal cord, a low radiation dose had to be used in the past. However, this is not sufficient to kill the metastases, which is why the pain flares up again after a few weeks to a few months in half of the patients.
In an international study, a research group led by Matthias Guckenberger, Director of the Department of Radiation Oncology at the University Hospital Zurich, has now investigated whether intensified precision radiotherapy can permanently kill eradicate spinal metastases and thus control pain in the long term. In the randomized comparison, standard radiotherapy was compared with intensified precision radiotherapy (called stereotactic radiotherapy or radiosurgery). The aim was an improvement in pain six months after radiotherapy.
The DOSIS study involved 15 centers from Switzerland, Belgium, Germany, Italy and Poland; 63 patients met all the criteria to be included in the study. Due to the slow recruitment of additional patients, the study, which began in 2016, was terminated and analyzed prematurely in 2023.
Significant pain reduction in two thirds of patients
Nevertheless, a significant advantage of intensified precision radiotherapy was shown for the patients: after six months, 69.4 percent of patients with precision radiotherapy reported a reduction in pain, compared to 41.9 percent in the group of patients with low-dose therapy. The values were recorded using a standardized scale. The improved efficacy of intensified precision radiotherapy was not associated with additional side effects compared to conventional radiotherapy.
“This study, developed and led at the USZ, is the first in the world to demonstrate not only a short-term but also a longer-term effect of intensified precision radiotherapy. Particularly in these times of personalized cancer treatment, more and more patients can benefit from this progress in radio-oncology,” says Prof. Guckenberger, summarizing the consequences of the DOSIS study. Further steps will be taken to improve the therapy based on the results of the DOSIS study.
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