Morphine After Radiofrequency Ablation of Painful Bone Metastases in Patients With Cancer (MEDOR)

Evaluation of the Effectiveness of the Radiofrequency Ablation for Reducing Refractory Pain From Bone Metastases

RATIONALE: Morphine may reduce pain in patients who have undergone radiofrequency ablation to remove bone metastases. PURPOSE: This phase II trial is studying how well morphine works after radiofrequency ablation of painful bone metastases in patients with cancer.

OBJECTIVES: Primary Measure the efficacy of morphine sulfate at 8 weeks after radiofrequency ablation (RFA) of bone metastases. Secondary Assess minimum and average pain and analyze use of morphine sulfate before and after RFA. Determine disease progression by CT scan of bone. Evaluate the percentage of relief associated with RFA, specifically patient satisfaction, quality of life, anxiety, depression, and physical performance during RFA. Assess complications and side effects related to RFA and the evolution of possible side effects associated with morphine sulfate therapy. OUTLINE: This is a multicenter study. Patients complete a pain questionnaire over 1 week before undergoing radiofrequency ablation (RFA). Patients also complete questionnaires about pain, physical performance, quality of life (QOL), and anxiety at baseline. Bone metastases are removed by radiofrequency ablation (RFA). After surgery, patients receive acetaminophen and patient-controlled analgesic (PCA) morphine sulfate. PCA morphine sulfate continues with a dose increase of 50% bolus every 24 hours. Patients with maximum pain less than or equal to that at inclusion receive standard morphine sulfate therapy instead. Data concerning the total dose of PCA morphine sulfate; minimum, average, and maximum pain intensity; side effects and complications of RFA; and total dose of morphine sulfate (or equivalent) is collected daily. Pain is assessed at 4 and 8 weeks after RFA. Patients complete follow-up questionnaires about physical performance, QOL, and anxiety at 12 weeks. Patients also undergo a CT scan at 12 weeks.

Patient who has undergone radiofrequency ablation of bone metastases, localized, causing pain refractory to radiotherapy or not accessible to new irradiation, biphosphonates and well-conducted morphine analgesic treatment.

Patient-controlled analgesia (PCA), allowing morphine consumption to be titrated to the patient's needs and thus allowing morphine doses to be adapted to an increase in pain in the patient's post-operative period or a rapid analgesic effect of radiofrequency.

Pain notebook will allow the patient to describe the pain specific to the metastasis concerned, containing information on : The intensity of the minimum, average and maximum pain of the last 24 months. hours as well as the intensity of the pain of the moment according to a scale 11-point digital, the background morphine analgesic treatment during the last 24 hours, the morphine analgesic treatment taken during painful attacks, the possible undesirable effects of morphine treatment. the morphinic, non-morphinic and co-antalgic treatment is noted, as well as that the total dose of oral morphine or oral morphine equivalent

Patients' quality of life will be assessed using the quality of life questionnaire EORTC QLQ-C30 at inclusion in the study and at 8 weeks after radiofrequency. ablation.

Recent technique of thermal destruction of tumors. This technique consists of inserting an electrode needle into the tumour under X-ray or ultrasound guidance or intraoperatively under laparoscopy for example. This needle carries a current or a light wave depending on the characteristics of the generator to which it is connected (radiofrequency, laser). Radio frequencies are radiation non-ionising electromagnets. In this context of tissue ablathermia wavelengths ranging from 400kHz to 500kHz.

Percentage of Participants With Maximum Pain Level Decreased by ≥ 2 Points at 2 Months After Radiofrequency Ablation (RFA)

Difference in maximum pain scores between inclusion and 2 months after radiofrequency ablation (RFA) according to an 11-point numerical scale Rate of patients with a decrease of two or more points in their most intense pain, 2 months after the radiofrequency ablation. This rate is calculated for the evaluable population for the principal outcome measure. This rate is equal to the ratio of the number of patients with a decrease of two or more points in their maximum pain divided by the size of the evaluable population. The response rate considered acceptable is 50%, above this threshold the treatment will be considered potentially effective and may be proposed in phase III.

Difference in maximum pain scores between inclusion and 2 months after radiofrequency ablation (RFA) according to a discrete 11-points numerical scale. Increased/decreased pain is considered as a variation of at least one point on the numerical scale. If 25 patients or more are observed with pain reduction of 2 or more points, then the treatment will be considered potentially effective.

According to a discrete 11-points numerical scale which ranges from 0 (low pain) to 11 (intense pain), intensity of pain (Minimum, Average, Maximum) has been evaluated at different time point between pre-selection and up to 3 months after radiofrequency. Assessment of intensity of pain has been done in this order at: Pre-selection visit: First algology assessment within a week (± 3 days) after the radiology consultation, Inclusion visit: Second algology assessment (One week after the first algology assessment) J-1: one day before radiofrequency J+1: One day after radiofrequency Discharge from hospital 7 days after discharge from hospital 1 month after radiofrequency 2 months after radiofrequency 3 months after radiofrequency Here, are presented only data collected at the pre-selection visit.

According to a discrete 11-points numerical scale which ranges from 0 (low pain) to 11 (intense pain), intensity of pain (Minimum, Average, Maximum) has been evaluated at different time point between pre-selection and up to 3 months after radiofrequency. Assessment of intensity of pain has been done in this order at: Pre-selection visit: First algology assessment within a week (± 3 days) after the radiology consultation, Inclusion visit: Second algology assessment (One week after the first algology assessment) J-1: one day before radiofrequency J+1: One day after radiofrequency Discharge from hospital 7 days after discharge from hospital 1 month after radiofrequency 2 months after radiofrequency 3 months after radiofrequency Here, are presented only data collected at the inclusion visit.

According to a discrete 11-points numerical scale which ranges from 0 (low pain) to 11 (intense pain), intensity of pain (Minimum, Average, Maximum) has been evaluated at different time point between pre-selection and up to 3 months after radiofrequency. Assessment of intensity of pain has been done in this order at: Pre-selection visit: First algology assessment within a week (± 3 days) after the radiology consultation, Inclusion visit: Second algology assessment (One week after the first algology assessment) J-1: one day before radiofrequency J+1: One day after radiofrequency Discharge from hospital 7 days after discharge from hospital 1 month after radiofrequency 2 months after radiofrequency 3 months after radiofrequency Here, are presented only data collected one day before radiofrequency (J-1).

According to a discrete 11-points numerical scale which ranges from 0 (low pain) to 11 (intense pain), intensity of pain (Minimum, Average, Maximum) has been evaluated at different time point between pre-selection and up to 3 months after radiofrequency. Assessment of intensity of pain has been done in this order at: Pre-selection visit: First algology assessment within a week (± 3 days) after the radiology consultation, Inclusion visit: Second algology assessment (One week after the first algology assessment) J-1: one day before radiofrequency J+1: One day after radiofrequency Discharge from hospital 7 days after discharge from hospital 1 month after radiofrequency 2 months after radiofrequency 3 months after radiofrequency Here, are presented only data collected one day after radiofrequency (J+1).

According to a discrete 11-points numerical scale which ranges from 0 (low pain) to 11 (intense pain), intensity of pain (Minimum, Average, Maximum) has been evaluated at different time point between pre-selection and up to 3 months after radiofrequency. Assessment of intensity of pain has been done in this order at: Pre-selection visit: First algology assessment within a week (± 3 days) after the radiology consultation, Inclusion visit: Second algology assessment (One week after the first algology assessment) J-1: one day before radiofrequency J+1: One day after radiofrequency Discharge from hospital 7 days after discharge from hospital 1 month after radiofrequency 2 months after radiofrequency 3 months after radiofrequency Here, are presented only data collected at the discharge from hospital visit.

According to a discrete 11-points numerical scale which ranges from 0 (low pain) to 11 (intense pain), intensity of pain (Minimum, Average, Maximum) has been evaluated at different time point between pre-selection and up to 3 months after radiofrequency. Assessment of intensity of pain has been done in this order at: Pre-selection visit: First algology assessment within a week (± 3 days) after the radiology consultation, Inclusion visit: Second algology assessment (One week after the first algology assessment) J-1: one day before radiofrequency J+1: One day after radiofrequency Discharge from hospital 7 days after discharge from hospital 1 month after radiofrequency 2 months after radiofrequency 3 months after radiofrequency Here, are presented only data collected 7 days after discharge from hospital.

According to a discrete 11-points numerical scale which ranges from 0 (low pain) to 11 (intense pain), intensity of pain (Minimum, Average, Maximum) has been evaluated at different time point between pre-selection and up to 3 months after radiofrequency. Assessment of intensity of pain has been done in this order at: Pre-selection visit: First algology assessment within a week (± 3 days) after the radiology consultation, Inclusion visit: Second algology assessment (One week after the first algology assessment) J-1: one day before radiofrequency J+1: One day after radiofrequency Discharge from hospital 7 days after discharge from hospital 1 month after radiofrequency 2 months after radiofrequency 3 months after radiofrequency Here, are presented only data collected 1 month after radiofrequency.

According to a discrete 11-points numerical scale which ranges from 0 (low pain) to 11 (intense pain), intensity of pain (Minimum, Average, Maximum) has been evaluated at different time point between pre-selection and up to 3 months after radiofrequency. Assessment of intensity of pain has been done in this order at: Pre-selection visit: First algology assessment within a week (± 3 days) after the radiology consultation, Inclusion visit: Second algology assessment (One week after the first algology assessment) J-1: one day before radiofrequency J+1: One day after radiofrequency Discharge from hospital 7 days after discharge from hospital 1 month after radiofrequency 2 months after radiofrequency 3 months after radiofrequency Here, are presented only data collected 2 months after radiofrequency.

According to a discrete 11-points numerical scale which ranges from 0 (low pain) to 11 (intense pain), intensity of pain (Minimum, Average, Maximum) has been evaluated at different time point between pre-selection and up to 3 months after radiofrequency. Assessment of intensity of pain has been done in this order at: Pre-selection visit: First algology assessment within a week (± 3 days) after the radiology consultation, Inclusion visit: Second algology assessment (One week after the first algology assessment) J-1: one day before radiofrequency J+1: One day after radiofrequency Discharge from hospital 7 days after discharge from hospital 1 month after radiofrequency 2 months after radiofrequency 3 months after radiofrequency Here, are presented only data collected 3 months after radiofrequency.

Oral Morphine Consumption or Oral Morphine Equivalent (Immediate and Sustained Release Forms) (mg) Per Day

Patients were provided with a pain notebook. This notebook allowed the patient to describe the pain specific to the metastasis concerned. In particular, information about the dose of oral morphine consumption or oral morphine equivalent in mg per day. This pain notebook has been evaluated between the radiology consultation and three months after radiofrequency.

Oral Morphine Consumption or Oral Morphine Equivalent (Immediate and Sustained Release Forms) (mg) Per Day

Patients were provided with a pain notebook. This notebook allowed the patient to describe the pain specific to the metastasis concerned. In particular, information about the dose of oral morphine consumption or oral morphine equivalent in mg per day. This pain notebook has been evaluated between the radiology consultation and three months after radiofrequency.

Oral Morphine Consumption or Oral Morphine Equivalent (Immediate and Sustained Release Forms) (mg) Per Day

Patients were provided with a pain notebook. This notebook allowed the patient to describe the pain specific to the metastasis concerned. In particular, information about the dose of oral morphine consumption or oral morphine equivalent in mg per day. This pain notebook has been evaluated between the radiology consultation and three months after radiofrequency.

Oral Morphine Consumption or Oral Morphine Equivalent (Immediate and Sustained Release Forms) (mg) Per Day

Patients were provided with a pain notebook. This notebook allowed the patient to describe the pain specific to the metastasis concerned. In particular, information about the dose of oral morphine consumption or oral morphine equivalent in mg per day. This pain notebook has been evaluated between the radiology consultation and three months after radiofrequency.

Oral Morphine Consumption or Oral Morphine Equivalent (Immediate and Sustained Release Forms) (mg) Per Day

Patients were provided with a pain notebook. This notebook allowed the patient to describe the pain specific to the metastasis concerned. In particular, information about the dose of oral morphine consumption or oral morphine equivalent in mg per day. This pain notebook has been evaluated between the radiology consultation and three months after radiofrequency.

Oral Morphine Consumption or Oral Morphine Equivalent (Immediate and Sustained Release Forms) (mg) Per Day

Patients were provided with a pain notebook. This notebook allowed the patient to describe the pain specific to the metastasis concerned. In particular, information about the dose of oral morphine consumption or oral morphine equivalent in mg per day. This pain notebook has been evaluated between the radiology consultation and three months after radiofrequency.

Oral Morphine Consumption or Oral Morphine Equivalent (Immediate and Sustained Release Forms) (mg) Per Day

Patients were provided with a pain notebook. This notebook allowed the patient to describe the pain specific to the metastasis concerned. In particular, information about the dose of oral morphine consumption or oral morphine equivalent in mg per day. This pain notebook has been evaluated between the radiology consultation and three months after radiofrequency.

Oral Morphine Consumption or Oral Morphine Equivalent (Immediate and Sustained Release Forms) (mg) Per Day

Patients were provided with a pain notebook. This notebook allowed the patient to describe the pain specific to the metastasis concerned. In particular, information about the dose of oral morphine consumption or oral morphine equivalent in mg per day. This pain notebook has been evaluated between the radiology consultation and three months after radiofrequency.

Total intravenous dose of morphine 24 hours after the radiofrequency was assessed during the patient's hospital stay. As a reminder, the post-operative analgesic treatment included intravenous paracetamol (4 g / 24h) and patient-controlled analgesia (PCA).

As a reminder, the post-operative analgesic treatment included intravenous paracetamol (4 g / 24h) and patient-controlled analgesia (PCA).

Quality of life Questionnaire -Core 30 (QLQ-C30) developed in 1986 by the European Organization for Research and Treatment of Cancer (EORTC) assesses quality of life across 15 dimensions : 5 functional dimensions : Physical functioning, Role functioning, Emotional, Cognitive functioning, Social functioning; 9 symptomatic dimensions: Fatigue, Nausea and vomiting, Pain, Dyspnea, Insomnia, Appetite loss, Diarrhoea, Financial difficulties; 1 global health dimension: Global health status/QoL Each dimension is a standardised score ranges from 0 to 100. A low score corresponds to a low functional level, an absence of symptoms or a low level of QoL/ overall health and, conversely, so that a high score corresponds to a high functional level, a high presence of symptoms or a high level of QoL/overall health.

Quality of life Questionnaire -Core 30 (QLQ-C30) developed in 1986 by the European Organization for Research and Treatment of Cancer (EORTC) assesses quality of life across 15 dimensions : 5 functional dimensions : Physical functioning, Role functioning, Emotional, Cognitive functioning, Social functioning; 9 symptomatic dimensions: Fatigue, Nausea and vomiting, Pain, Dyspnea, Insomnia, Appetite loss, Diarrhoea, Financial difficulties; 1 global health dimension: Global health status/QoL Each dimension is a standardised score ranges from 0 to 100. A low score corresponds to a low functional level, an absence of symptoms or a low level of QoL/ overall health and, conversely, so that a high score corresponds to a high functional level, a high presence of symptoms or a high level of QoL/overall health.

DISEASE CHARACTERISTICS: Histologically confirmed cancer Primary or unknown origin Painful bone metastases despite radiotherapy or symptomatic relapse into previously irradiated area with no possibility of repeating radiotherapy Bone metastases may have been treated with bisphosphonates Osteolytic bone or joint (lytic and condensed) confirmed by CT scan and meeting the following criteria: Lesion size ≤ 5 cm No more than 2 painful bone metastases If 2 lesions are to be treated, distinct anatomical locations can be treated at the same time Metastatic bone lesions of the pelvis, sacrum (in absence of canal involvement), ribs, or long bones allowed Pain located at the tumor or in the area Maximum pain in the last 24 hours > 4 points (numerical scale to 11 points) PATIENT CHARACTERISTICS: Life expectancy > 3 months Platelet count > 50,000/μL Prothrombin < 50% Activated cephalin time ≤ 1.5 times normal Not pregnant Fertile patients must use effective contraception No geographical, social, or psychiatric reason that would preclude follow up PRIOR CONCURRENT THERAPY: See Disease Characteristics At least 4 weeks since prior radiotherapy At least 3 weeks since prior chemotherapy or bisphosphonates At least 1 week since beginning new painkiller therapy or anticoagulation treatment More than 30 days since participation in another drug study More than 30 days since prior surgery

http://www.e-cancer.fr/Professionnels-de-sante/Le-registre-des-essais-cliniques/Le-registre-des-essais-cliniques/Etudes-cliniques/MEDOR-Essai-de-phase-2-evaluant-l-efficacite-antalgique-de-l-ablation-par-radiofrequence-de-metastases-osseuses-chez-des-patients-ayant-des-metastases-osseuses-a-l-origine-de-douleurs-refractaires-aux-traitements.-essai-clos-aux-inclusions