[en] Highlights: • MEDLINE (Ovid), EMBASE, and Cochrane Central Register of Controlled Trials were searched from database initiation (1946 for MEDLINE, 1974 for EMBASE, and 1995 for Cochrane) up until May 2021. • Eight studies were included in this review. Patients receiving neoadjuvant chemoradiotherapy with esophagectomy had better overall survival – HR 0.55; 95% CI: 0.49–0.62. • Toxicity was similar, between the two treatments. • Given the paucity of data and lack of uniform reporting of endpoints, further studies should be conducted. There currently exists limited data comparing definitive chemoradiotherapy to neoadjuvant chemoradiotherapy with esophagectomy for patients with esophageal carcinoma. While we await more trials, we conducted a systematic review and meta-analysis of randomized controlled trials and observational studies with either propensity score matched or multivariable analyses, to provide a better understanding of the relative efficacy and effectiveness.

[en] Background: Radiation therapy is effective for painful uncomplicated bone metastases, with multiple fraction radiation therapy (MFRT) administered frequently. The optimal dose for MFRT to yield maximum pain relief remains unclear. The aim of this systematic review was to determine pain response across MFRT doses. Methods: A literature search was conducted in Ovid MEDLINE(R) , Embase Classic & Embase and Cochrane Central Register of Controlled Trials . Pain response rates and the side effects for MFRT doses were extracted. Results: From the 3719 articles identified from the search, 17 were included for quantitative synthesis. 22.5 Gy/5 had the highest overall response (OR) rate, 30 Gy/15 had better complete response (CR) rate and 20 Gy/2 had better partial response (PR) rate. Only 4 of the 17 included studies directly compared MFRT doses with each other – one reported marginally-better OR for 24 Gy/6 over 20 Gy/2; another found 20 Gy/10 to be slightly more efficacious than 30 Gy/15 and 22.5 Gy/5 for OR. Two randomized trials compared 20 Gy/5 and 30 Gy/10 – one favored 20 Gy/5 while the other concluded 30 Gy/10 to be the better option. The overall rate of GI toxicities, nausea, and vomiting did not differ greatly between MFRT doses. Conclusion: No major difference exists between the schedules and toxic events studied in these trials. This is consistent with the wealth of randomized data which show no dose response for pain relief after radiotherapy for metastatic bone pain.

[en] Background and purpose: Single fraction radiation treatment (SFRT) is recommended for its equivalence to multiple-fraction (MF) RT in the palliation of uncomplicated bone metastases (BM). However, adoption of SFRT has been slow. Materials and methods: Literature searches for studies published following 2014 were conducted using online repositories of gray literature, Ovid MEDLINE, Embase and Embase Classic, and the Cochrane Central Register of Controlled Trials databases. Results: A total of 32 articles detailing patterns of practice and clinical practice guidelines were included for final synthesis. The majority of organizations have released high level recommendations for SFRT use in treatment of uncomplicated BM, based on evidence of non-inferiority to MFRT. There are key differences between guidelines, such as varying strengths of recommendation for SFRT use over MFRT; contraindication in vertebral sites for SFRT; and risk estimation of pathologic fractures after SFRT. Differences in guidelines may be influenced by committee composition and organization mandate. Differences in patterns of practice may be influenced by individual center policies, payment modalities and consideration of patient factors such as age, prognosis, and performance status. Conclusion: Although there is some variation between groups, the majority of guidelines recommend use of SFRT and others consider it to be a reasonable alternative to MFRT.

[en] Patient’s gender and age may influence physicians in prescribing palliative radiotherapy. The purpose of this secondary analysis of the National Cancer Institute of Canada Clinical Trials Group Symptom Control Trial SC.20 was to explore the gender and age differences in pain and patient reported outcomes in cancer patients with bone metastases undergoing re-irradiation.

[en] Radiation therapy is an effective modality for pain management of symptomatic bone metastases. We update the previous meta-analyses of randomized trials comparing single fraction to multiple fractions of radiation therapy in patients with uncomplicated bone metastases.