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TOPLINE:

Stereotactic body radiation therapy (SBRT) provides excellent local control and pain response with minimal toxicity in patients with nonspinal bone metastases.

METHODOLOGY:

• In patients with nonspinal bone metastases, pain relief with conventional radiotherapy often declines overtime. However, dose escalation through SBRT may provide durable local control and pain response.
• This meta-analysis pooled data from 528 patients (median age, 64 years) with 597 nonspinal bone metastases treated with SBRT across nine studies conducted between 2003 and 2021.
• Primary outcomes were local control at 1 year, incidences of acute and late grade 3-5 toxicities, and pain response rates at 3 months; overall survival was a secondary outcome.
• The most common primary cancer sites were prostate in 132 patients (25.0%), lung in 106 patients (20.1%), kidney in 76 patients (14.4%), and breast in 66 patients (12.5%). The median SBRT dose and fractionation were 35 Gy and 5 fractions, respectively.

TAKEAWAY:

• Patients receiving SBRT achieved a local control rate of 94.6% at 1 year.
• The partial and complete pain response rate at 3 months was 87.7% (94 of 107 patients with data on partial and complete pain response).
• Among the 256 patients with available information, 0.5% experienced grade 3-5 acute and late toxicities and 3.1% reported pathologic fractures following SBRT.
• Among the 460 patients with available information on overall survival, 71% were alive at 1 year.

IN PRACTICE:

These findings suggest that SBRT provides "excellent" local control and pain response that exceed historical outcomes with conventional radiotherapy and come "with minimal severe treatment-related toxicity," the authors concluded.

SOURCE:

This meta-analysis, led by Raj Singh, MD, from Virginia Commonwealth University Health System, Richmond, Virginia, was published last month in International Journal of Radiation Oncology, Biology, Physics.

LIMITATIONS:

Given the short median follow-up of 1-year, the researchers may have underestimated late toxicities such as long-term fracture risk or overestimated local control. The study included data from a heterogenous patient population, from institutions with different treatment guidelines, as well as from a combination of prospective and retrospective data, all of which may have impacted the analysis and outcomes. 

DISCLOSURES:

Two authors reported receiving research support and personal and consulting fees outside this work. Other authors reported no relevant conflicts of interest.