Prophylactic Radiation Therapy vs. Standard-of-Care for Patients with High-Risk, Asymptomatic Bone Metastases: A Multicenter, Randomized Phase II Trial

Editorial: Radiotherapy for prevention for pathological femoral fractures

“…In addition to the work by these authors, a similar study was presented in abstract form at the 2022 American Society of Radiation Oncology meeting; the authors of that phase II study found that prophylactic palliative RT to asymptomatic bone metastases decreased skeletal events, such as pathologic fracture (8). While we await the full publication of that study, we expect the outcome of both works to support ongoing research into this application of palliative RT.…”

Metastasis-Directed Therapy: A Moving Target Advancing Progress Forward

“…Using more ultra-hypofractionated approaches could therefore be beneficial in appropriately selected patients with evidence, suggesting that such an approach is associated with improved local control and pain response compared with conventional palliative dosing. 20 To this point, the most commonly used fractionation by Gillespie et al 12 was 27 Gy in three fractions and some evidence suggests that even dose escalation within SBRT fractionation is associated with improved local control. 21 Much remains to be learned about local therapies in metastatic disease, and numerous ongoing trials will provide us additional insight and help to develop novel treatment paradigms.…”

“…In the article that accompanies this editorial, Gillespie et al 12 demonstrate that prophylactic radiation of asymptomatic high-risk bone lesions reduces risk of skeletal-related events including pathologic fractures, spinal cord compression, and need for orthopedic surgery, and palliative radiation therapy for pain, and, in turn, may improve patient survival. Such findings suggest that clinical practice should be altered to proactively treat osseous metastases that are bulky, at risk of causing mass effect, or in weight-bearing areas to reduce the risk of pain, fracture, and need for invasive procedures associated with significant morbidity.…”

“…In the article that accompanies this editorial, Gillespie et al 12 take this an impressive step further in evaluating which patients with metastatic disease should receive local therapies. This prospective randomized phase II trial evaluated the use of prophylactic radiation versus standard-of-care therapy in patients with high-risk asymptomatic bone metastases.…”

“…(3) Prophylactic treatment of lesions with high risk of morbidity. On the basis of the accompanying study by Gillespie et al, 12 aggressively treating high-risk metastatic bone lesions can reduce morbidity and mortality, and unlike recent studies in oligometastasis, patients with high-volume disease were included, therefore significantly expanding who should be evaluated for MDT. Prophylactic radiation to high-risk bone lesions reduces risk of fracture, need for surgical intervention, pain, and hospitalization.…”