Palliative Efficacy of High-Dose Stereotactic Body Radiotherapy Versus Conventional Radiotherapy for Painful Non-Spine Bone Metastases: A Propensity Score-Matched Analysis

Abstract

(1) Background: The superiority of stereotactic body radiotherapy (SBRT) over conventional external beam radiotherapy (cEBRT) in terms of pain palliation for bone metastases remains controversial. (2) Methods: This propensity score-matched study compared the overall pain response (OR) 3 months after radiotherapy among patients with painful (≥2 points on a 0-to-10 scale) non-spine bone metastases. Patients with lesions that were treated with SBRT or cEBRT and whose pain scores were evaluated 3 months after radiotherapy were included in this study. Pain response was evaluated according to the International Consensus Criteria. (3) Results: A total of 234 lesions (SBRT, n = 129; cEBRT, n = 105) were identified in our institutional database. To reduce the confounding effects, 162 patients were selected using a propensity score-matched analysis (n = 81 for each treatment). The OR rate at 3 months after SBRT was significantly higher than that after cEBRT (76.5% vs. 56.8%; p = 0.012). A noteworthy finding of our study is that the same trend was observed even after 6 months (75.9% vs. 50.0%; p = 0.011). The 1-year local failure rates after SBRT and cEBRT were 10.2% and 33.3% (p < 0.001), respectively. (4) Conclusions: Our findings suggest that SBRT is superior to cEBRT for pain palliation in patients with non-spine bone metastases.

Stereotactic Body and Conventional Radiotherapy for Painful Bone Metastases

“…Finally, 18 comparative studies were included in the review, with 1685 patients. Of these 18 comparative studies, 3 studies published secondary outcomes from 2 included RCTs reporting on pain response. The funnel plots showed some asymmetry, suggesting limited publication bias (eFigure 2 in Supplement 1).…”

“…The search yielded 8284 unique articles. After title and abstract screening, 92 studies needed full-text screening, of which 17 studies 7 , 8 , 9 , 10 , 11 , 12 , 13 , 19 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 were included in the review. Additionally, we included 1 recently completed RCT 20 and the unpublished complete pain response data from an already published RCT 8 (eFigure 1 in Supplement 1 ).…”

“…Additionally, we included 1 recently completed RCT 20 and the unpublished complete pain response data from an already published RCT 8 (eFigure 1 in Supplement 1 ). Finally, 18 comparative studies 7 , 8 , 9 , 10 , 11 , 12 , 13 , 19 , 20 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 were included in the review, with 1685 patients. Of these 18 comparative studies 7 , 8 , 9 , 10 , 11 , 12 , 13 , 19 , 20 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 3 studies 34 , 35 , 36 published secondary outcomes from 2 included RCTs 8 , 33 reporting on pain response.…”

“…Since 2019, conflicting results from RCTs and comparative studies on pain response have been published . To aggregate the results of these newer studies, several meta-analyses assessed pain response for metastatic bone disease and again published conflicting conclusions .…”

“…Since 2019, conflicting results from RCTs and comparative studies on pain response have been published. 7 , 8 , 9 , 10 , 11 , 12 , 13 To aggregate the results of these newer studies, several meta-analyses assessed pain response for metastatic bone disease and again published conflicting conclusions. 14 , 15 , 16 , 17 , 18 In our review, we included the largest RCT 19 to our knowledge and an eighth RCT on this subject.…”