SBRT vs Conventional External-Beam Radiotherapy for Painful Bone Metastases

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In a systematic review and meta-analysis reported in JAMA Network Open, Bindels et al found no difference in overall pain response rates between stereotactic body radiotherapy (SBRT) and conventional external-beam radiotherapy (cEBRT) in terms of relief of pain for patients with painful bone metastases. However, SBRT was associated with a higher rate of complete pain response.

Study Details

The meta-analysis included eight randomized clinical trials involving 1,090 patients; of these, 462 (47%) underwent cEBRT and 518 (53%) underwent SBRT. Overall pain response was defined according to the International Consensus on Palliative Radiotherapy Endpoints in clinical trials. Complete pain response was reported in six randomized clinical trials. The primary outcome measure was overall and complete pain response at 1, 3, and 6 months after radiotherapy in the intention-to-treat population.

Key Findings

Overall pain response rates did not significantly differ between cEBRT and SBRT at 1 month (relative risk ratio [RR] = 1.14, 95% confidence interval [CI] = 0.99–1.30), 3 months (RR = 1.19, 95% CI = 0.96–1.47), or 6 months (RR = 1.22, 95% CI = 0.96–1.54) after radiotherapy.

SBRT was associated with higher rates of complete pain response at 1 month (RR = 1.43, 95% CI = 1.02–2.01), 3 months (RR = 1.80, 95% CI = 1.16–2.78), and 6 months (RR = 2.47, 95% CI = 1.24–4.91) after radiotherapy.

The investigators concluded, “In 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.”

Joanne M. van der Velden, MD, PhD, of the Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands, is the corresponding author for the JAMA Network Open article.

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