A phase III randomized-controlled, single-blind trial to improve quality of life with stereotactic body radiotherapy for patients with painful bone metastases (ROBOMET)

Abstract

Background Bone metastases represent an important source of morbidity in cancer patients, mostly due to severe pain. Radiotherapy is an established symptomatic treatment for painful bone metastases, however, when conventional techniques are used, the effectiveness is moderate. Stereotactic body radiotherapy (SBRT), delivering very high doses in a limited number of fractions in a highly conformal manner, could potentially be more effective and less toxic. Methods This is a phase III, randomized-controlled, single-blind, multicenter study evaluating the response rate of antalgic radiotherapy for painful bone metastases and the acute toxicity associated with this treatment. A total of 126 patients will be randomly assigned to receive either the standard schedule of a single fraction of 8.0 Gy delivered through three-dimensional conformal radiotherapy or a single fraction of 20.0 Gy delivered through SBRT. Primary endpoint is pain response at the treated site at 1 month after radiotherapy. Secondary endpoints are pain flare at 24–48-72 h after radiotherapy, duration of pain response, re-irradiation need, acute toxicity, late toxicity, quality of life and subsequent serious skeletal events. In a supplementary analysis, patient-compliance for a paper-and-pencil questionnaire will be compared with an electronic mode. Discussion If a dose-escalated approach within the context of single fraction stereotactic body radiotherapy could improve the pain response to radiotherapy and minimize acute toxicity, this would have an immediate impact on the quality of life for a large number of patients with advanced cancer. Potential disadvantages of this technique include increased pain flare or a higher incidence of radiation-induced fractures. Trial registration The Ethics committee of the GZA Hospitals (B099201732915) approved this study on September 4th 2018. Trial registered on Clinicaltrials.gov ( NCT03831243 ) on February 5th 2019.

Patient-Reported Outcomes of Oligometastatic Patients After Conventional or Stereotactic Radiation Therapy to Bone Metastases: An Analysis of the PRESENT Cohort

“…32 Results of more ongoing RCTs are needed to determine the role of SBRT in the palliative treatment of bone metastases. 26,33,34 We showed that the duration of the response and the percentages of ongoing pain responses did not differ, despite the higher complete response rates at certain follow-up time points in the SBRT group. In addition, patients showed fluctuating pain responses during follow-up.…”

Quality of life improvement in patients with bone metastases undergoing palliative radiotherapy

“…Indeed, several studies have been published comparing the effectiveness between SBRT and conventional RT [32][33][34][35][36][37]. Indeed, there are potential disadvantages of SBRT, including possible increased pain flare or a higher incidence of radiation-induced fractures [38].…”

“…Indeed, several studies have been published comparing the effectiveness between SBRT and conventional RT [ 32 – 37 ]. Indeed, there are potential disadvantages of SBRT, including possible increased pain flare or a higher incidence of radiation-induced fractures [ 38 ]. However, if a dose-escalated approach within the context SBRT could improve the pain response to radiotherapy and reduce acute toxicity, this would have a significant impact on the QoL for a large number of patients with advanced metastatic disease.…”

“…However, if a dose-escalated approach within the context SBRT could improve the pain response to radiotherapy and reduce acute toxicity, this would have a significant impact on the QoL for a large number of patients with advanced metastatic disease. In this context, there is a future avenue of research to confirm this hypothesis [ 38 ].…”

Stereotactic Ablative Radiation Therapy to All Lesions in Patients With Oligometastatic Cancers: A Phase 1 Dose-Escalation Trial

“…Currently, our center is evaluating SABR in the setting of antalgic treatment for bone metastases. 21 In that trial, patients are simulated and treated in 1 day, suggesting that it is feasible to give these high-precision treatments to all patients.…”