Stereotactic body radiotherapy versus conventional radiotherapy for painful bone metastases: a systematic review and meta-analysis of randomised controlled trials

Ito, Kei; Saitô, Tetsuo; Nakamura, Naoki; Imano, Nobuki; Hoskin, Peter

doi:10.1186/s13014-022-02128-w

Cited by 15 publications

(9 citation statements)

References 33 publications

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“…Results and conclusions gleaned from systematic reviews and meta-analyses of SBRT versus conventional radiotherapy for symptomatic bone metastases are conflicting [ 35 – 37 ]. Four such meta-analyses consider the combination of spine and non-spine sites.…”

Section: Sbrt For Symptomatic Bone Metastasesmentioning

confidence: 99%

“…Four such meta-analyses consider the combination of spine and non-spine sites. Ito et al’s meta-analysis demonstrated no statistical difference between conventional and SBRT for overall pain response, adverse events, quality of life or overall survival [ 35 ]. In contrast, Lee et al’s meta-analysis demonstrated that SBRT reduced rates of progression, improved complete pain response rates at 3 months, and increases the likelihood of pain flares [ 36 ].…”

Section: Sbrt For Symptomatic Bone Metastasesmentioning

confidence: 99%

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An Update on the Management of Bone Metastases

Grosinger,

Alcorn

2024

Curr Oncol Rep

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Purpose of Review Increasing life expectancy among patients with advanced cancer has placed a greater emphasis on optimizing pain control and quality of life. Concurrently, significant advancements in radiotherapy for bone metastases have permitted for dose escalation strategies such as stereotactic radiotherapy. This review aims to provide updated information on the management of bone metastases in light of these developments. Recent Findings We reviewed recent studies regarding the role and details of external beam radiotherapy for bone metastases, with emphasis on differences by treatment site as well as intention (palliative versus ablative for oligometastases). Conventional palliative radiotherapy remains a mainstay of management. While stereotactic radiotherapy may augment durability of pain relief and even survival time, there are significant questions remaining regarding optimal dosing and patient selection. Summary Radiotherapy for bone metastases continues to evolve, particularly with increasing use of stereotactic radiotherapy. Future studies are needed to clarify optimal dose, fractionation, modality, and patient selection criteria among different radiotherapy approaches.

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Section: Sbrt For Symptomatic Bone Metastasesmentioning

confidence: 99%

Section: Sbrt For Symptomatic Bone Metastasesmentioning

confidence: 99%

An Update on the Management of Bone Metastases

Grosinger,

Alcorn

2024

Curr Oncol Rep

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“…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 . In our review, we included the largest RCT to our knowledge and an eighth RCT on this subject .…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Body and Conventional Radiotherapy for Painful Bone Metastases

Bindels,

Mercier,

Gal

et al. 2024

JAMA Netw Open

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ImportanceConventional external beam radiotherapy (cEBRT) and stereotactic body radiotherapy (SBRT) are commonly used treatment options for relieving metastatic bone pain. The effectiveness of SBRT compared with cEBRT in pain relief has been a subject of debate, and conflicting results have been reported.ObjectiveTo compare the effectiveness associated with SBRT vs cEBRT for relieving metastatic bone pain.Data SourcesA structured search was performed in the PubMed, Embase, and Cochrane databases on June 5, 2023. Additionally, results were added from a new randomized clinical trial (RCT) and additional unpublished data from an already published RCT.Study SelectionComparative studies reporting pain response after SBRT vs cEBRT in patients with painful bone metastases.Data Extraction and SynthesisTwo independent reviewers extracted data from eligible studies. Data were extracted for the intention-to-treat (ITT) and per-protocol (PP) populations. The study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.Main Outcomes and MeasuresOverall and complete pain response at 1, 3, and 6 months after radiotherapy, according to the study’s definition. Relative risk ratios (RRs) with 95% CIs were calculated for each study. A random-effects model using a restricted maximum likelihood estimator was applied for meta-analysis.ResultsThere were 18 studies with 1685 patients included in the systematic review and 8 RCTs with 1090 patients were included in the meta-analysis. In 7 RCTs, overall pain response was defined according to the International Consensus on Palliative Radiotherapy Endpoints in clinical trials (ICPRE). The complete pain response was reported in 6 RCTs, all defined according to the ICPRE. The ITT meta-analyses showed that the overall pain response rates did not differ between cEBRT and SBRT at 1 (RR, 1.14; 95% CI, 0.99-1.30), 3 (RR, 1.19; 95% CI, 0.96-1.47), or 6 (RR, 1.22; 95% CI, 0.96-1.54) months. However, SBRT was associated with a higher complete pain response at 1 (RR, 1.43; 95% CI, 1.02-2.01), 3 (RR, 1.80; 95% CI, 1.16-2.78), and 6 (RR, 2.47; 95% CI, 1.24-4.91) months after radiotherapy. The PP meta-analyses showed comparable results.Conclusions and RelevanceIn this systematic review and meta-analysis, patients with painful bone metastases experienced similar overall pain response after SBRT compared with cEBRT. More patients had complete pain alleviation after SBRT, suggesting that selected subgroups will benefit from SBRT.

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“…Extreme hypofractionation cuts treatment duration into a fraction of what is needed to complete traditional regimens, e.g. 3 Gy × 10 [ 6 ]. As suggested by a recent large meta-analysis [ 7 ], there is room for improvement of physicians’ prescription habits or ability to decipher prognosis, because the authors found that 16% of patients with advanced cancer receiving palliative radiotherapy died within 30 days of treatment.…”

Section: Introductionmentioning

confidence: 99%

Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

et al. 2023

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Background This study analyzed mortality after radiotherapy for bone metastases (287 courses). Endpoints such as treatment in the last month of life and death within 30, 35 and 40 days from start of radiotherapy were evaluated. Methods Different baseline parameters including but not limited to blood test results and patterns of metastases were assessed for association with early death. After univariate analyses, multi-nominal logistic regression was employed. Results Of 287 treatment courses, 42 (15%) took place in the last month of life. Mortality from start of radiotherapy was 13% (30-day), 15% (35-day) and 18% (40-day), respectively. We identified three significant predictors of 30-day mortality (performance status (≤ 50, 60–70, 80–100), weight loss of at least 10% within 6 months (yes/no), pleural effusion (present/absent)) and employed these to construct a predictive model with 5 strata and mortality rates of 0–75%. All predictors of 30-day mortality were also associated with both, 35- and 40-day mortality. Conclusion Early death was not limited to the first 30 days after start of radiotherapy. For different cut-off points, similar predictive factors emerged. A model based on three robust predictors was developed.

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Stereotactic body radiotherapy versus conventional radiotherapy for painful bone metastases: a systematic review and meta-analysis of randomised controlled trials

Cited by 15 publications

References 33 publications

An Update on the Management of Bone Metastases

An Update on the Management of Bone Metastases

Stereotactic Body and Conventional Radiotherapy for Painful Bone Metastases

Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

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