A definition of “uncomplicated bone metastases” based on previous bone metastases radiation trials comparing single-fraction and multi-fraction radiation therapy

Cheon, Paul; Wong, Erin; Thavarajah, Nemica; Dennis, Kristopher; Lutz, S; Zeng, Liang; Chow, Edward

doi:10.1016/j.jbo.2014.12.001

Cited by 47 publications

(31 citation statements)

References 24 publications

(47 reference statements)

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“…A more robust definition of "uncomplicated" bone metastases will aid decision-making for surgery and fractionation, although 1 recent paper does review the topic and state, "Uncomplicated" bone metastases can be defined as: presence of painful bone metastases unassociated with impending or existing pathologic fracture or existing spinal cord or cauda equina compression." 38 The value of intensity modulated RT and image guided RT for patients receiving standard fractionation for new and recurrent painful lesions needs to be determined. Similarly, completion of prospective, randomized trials will better define proper use of SBRT for newly discovered and recurrent spine bone lesions.…”

Section: Future Directionsmentioning

confidence: 99%

Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline

Lutz¹,

Balboni

Jones

et al. 2017

Practical Radiation Oncology

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Updated data analysis confirms that radiation therapy provides excellent palliation for painful bone metastases and that retreatment is safe and effective. Although adherence to evidence-based medicine is critical, thorough expert radiation oncology physician judgment and discretion regarding number of fractions and advanced techniques are also essential to optimize outcomes when considering the patient's overall health, life expectancy, comorbidities, tumor biology, anatomy, previous treatment including prior radiation at or near current site of treatment, tumor and normal tissue response history to local and systemic therapies, and other factors related to the patient, tumor characteristics, or treatment.

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Section: Future Directionsmentioning

confidence: 99%

Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline

Lutz¹,

Balboni

Jones

et al. 2017

Practical Radiation Oncology

Self Cite

365

269

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show abstract

“…RCTs and nonrandomized studies have different patient populations, and both types of studies may reach different conclusions, even after adjusting for known prognostic factors 11 . In addition, patients with complicated BM (ie, impending or existing pathologic fracture, spinal cord compression, or cauda equina compression) were excluded from most RCTs on RT for BM 12 . This exclusion of patients with complicated BM limits the generalizability of RCTs.…”

Section: Introductionmentioning

confidence: 99%

Single- Versus Multiple-Fraction Radiation Therapy for Painful Bone Metastases: A Systematic Review and Meta-analysis of Nonrandomized Studies

Saitô

Yamaguchi

Toya

et al. 2019

Advances in Radiation Oncology

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PurposeSingle-fraction radiation therapy (RT) is a convenient and cost-effective regimen for the palliation of painful bone metastases, but is still underused. Randomized controlled trials comparing single- versus multiple-fraction RT are limited by generalizability. We compared the pain response rates after single- versus multiple-fraction RT in nonrandomized studies.Methods and MaterialsWe searched PubMed and Scopus from the inception of each database through August 2018. We sought to identify nonrandomized studies in which data on pain response rates could be extracted for single- and multiple-fraction RT. Our primary outcomes of interest were the overall and complete pain response rates in evaluable patients. The analysis was performed using a random-effects model with the Mantel-Haenszel method.ResultsOf the 3933 articles identified through our search, 9 met our inclusion criteria. Five of 9 included studies did not exclude patients with features of complicated bone metastases. A 1 × 8 Gy radiation schedule was frequently used in single-fraction therapy, and schedules of 5 × 4 Gy and 10 × 3 Gy were frequently used in multiple-fraction therapy. In the 9 studies, the overall response rate was 67% (884 of 1321 patients) for patients in the single-fraction arm and 70% (953 of 1360 patients) for those in the multiple-fraction arm (pooled odds ratio [OR]: 0.85; 95% confidence interval [CI], 0.66-1.08). In 5 studies, the complete response rate was 26% (195 of 753 patients) for patients in the single-fraction arm and 35% (289 of 821 patients) for those in the multiple-fraction arm (pooled OR: 0.89; 95% CI, 0.70-1.13).ConclusionsThere were no significant differences in the overall and complete response rates between single- and multiple-fraction RT. The effectiveness of single-fraction regimens was shown in nonrandomized settings, which better reflect daily practice than randomized studies. The CIs for the pooled ORs included clinically meaningful differences, and the study results are inconclusive.

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“…Bone metastasis in previously irradiated sites, or originating from myeloma, or complicated bone metastasis, i.e. impending and/or existing pathological fracture, spinal cord compression or cauda equina compression [11], should be excluded.…”

Section: Methodsmentioning

confidence: 99%

A phase III randomized-controlled, single-blind trial to improve quality of life with stereotactic body radiotherapy for patients with painful bone metastases (ROBOMET)

et al. 2019

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Background Bone metastases represent an important source of morbidity in cancer patients, mostly due to severe pain. Radiotherapy is an established symptomatic treatment for painful bone metastases, however, when conventional techniques are used, the effectiveness is moderate. Stereotactic body radiotherapy (SBRT), delivering very high doses in a limited number of fractions in a highly conformal manner, could potentially be more effective and less toxic. Methods This is a phase III, randomized-controlled, single-blind, multicenter study evaluating the response rate of antalgic radiotherapy for painful bone metastases and the acute toxicity associated with this treatment. A total of 126 patients will be randomly assigned to receive either the standard schedule of a single fraction of 8.0 Gy delivered through three-dimensional conformal radiotherapy or a single fraction of 20.0 Gy delivered through SBRT. Primary endpoint is pain response at the treated site at 1 month after radiotherapy. Secondary endpoints are pain flare at 24–48-72 h after radiotherapy, duration of pain response, re-irradiation need, acute toxicity, late toxicity, quality of life and subsequent serious skeletal events. In a supplementary analysis, patient-compliance for a paper-and-pencil questionnaire will be compared with an electronic mode. Discussion If a dose-escalated approach within the context of single fraction stereotactic body radiotherapy could improve the pain response to radiotherapy and minimize acute toxicity, this would have an immediate impact on the quality of life for a large number of patients with advanced cancer. Potential disadvantages of this technique include increased pain flare or a higher incidence of radiation-induced fractures. Trial registration The Ethics committee of the GZA Hospitals (B099201732915) approved this study on September 4th 2018. Trial registered on Clinicaltrials.gov ( NCT03831243 ) on February 5th 2019.

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A definition of “uncomplicated bone metastases” based on previous bone metastases radiation trials comparing single-fraction and multi-fraction radiation therapy

Cited by 47 publications

References 24 publications

Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline

Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline

Single- Versus Multiple-Fraction Radiation Therapy for Painful Bone Metastases: A Systematic Review and Meta-analysis of Nonrandomized Studies

A phase III randomized-controlled, single-blind trial to improve quality of life with stereotactic body radiotherapy for patients with painful bone metastases (ROBOMET)

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