Patient-Reported Outcomes of Oligometastatic Patients After Conventional or Stereotactic Radiation Therapy to Bone Metastases: An Analysis of the PRESENT Cohort

Abstract

This study shows the paradigm shift toward radical treatment in oligometastastic disease. Survival outcomes of patients with oligometastates are improving, and therefore optimization of palliative care is needed. Clinical local control rates are higher after stereotactic body radiation therapy to bone metastastes compared with conventional radiation therapy, but stereotactic body radiation therapy does not improve pain response or quality of life in oligometastastic patients. Purpose: Stereotactic body radiation therapy (SBRT) has become a widely adopted treatment for patients with oligometastatic disease, despite limited evidence of superiority. We compared pain response and quality of life (QoL) in patients with oligometastatic disease treated with conventionally fractionated 3-dimensional radiation therapy (3DCRT) or SBRT to bone metastases. Methods and Materials: We included patients with oligometastatic disease (5 lesions within 3 organs) treated within the prospective PRESENT cohort. Main outcomes were pain response, clinical local control, and QoL 2, 4, and 8 weeks and 3, 6, and 12 months after treatment. Pain response was assessed only in patients who reported pain at baseline and was defined according to international consensus criteria. Results: Of 131 patients with oligometastatic disease, 66 patients were treated with 3DCRT and 65 patients with SBRT. A pain response was achieved in 81% (3DCRT) versus 84% (SBRT) with a median duration of 23 weeks (range, 1-58) and 24 weeks (range, 0-50), respectively. Reirradiation was needed in 33% versus 5% of the patients, respectively. None of the QoL subscales were significantly different between both groups. Conclusions: In patients with oligometastatic disease, SBRT to bone metastases did not improve pain response or QoL compared with 3DCRT. Reirradiation was less often needed in the SBRT group.

Pain Response After Stereotactic Body Radiation Therapy Versus Conventional Radiation Therapy in Patients With Bone Metastases—A Phase 2 Randomized Controlled Trial Within a Prospective Cohort

“…It has been hypothesized that the duration of response is longer after SBRT because of higher local control. 9,30 Because only 39% of the patients completed the questionnaires at all follow-up time points, we were unable to make a reliable estimate of the duration of pain response to confirm this suggestion. Furthermore, local control was not assessed in the present study.…”

“…1,2 Palliative radiation therapy (RT) is a proven effective and widely accepted treatment modality for metastatic bone pain. 3,4 Pain response after conventional RT (cRT) is similar in patients treated with single-fraction (8 Gy in 1 fraction) and multifraction (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) Gy in 5-10 fractions) RT. 1,5,6 It has been suggested that dose escalation, and more specifically dose escalation per fraction, could improve pain response in patients with metastatic bone pain.…”

Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Study

“…Although this is not a comparative trial, EBRT, the current gold standard for pain palliation from osseous metastases, is limited in effectiveness with partial and complete response estimated at 60 and 33%, respectively [ 20 ]. Attempts to improve on palliation using SBRT failed to produce any meaningful differences in two prospective comparative trials [ 21 , 22 ]. A recently published randomized controlled trial did demonstrate differences, but these were not evident until 3 months post-treatment and the SBRT arm suffered from radiation-induced fractures as well as pain flare at 1-month in 11 and 43% of subjects, respectively [ 23 ].…”

ESTRO ACROP guidelines for external beam radiotherapy of patients with uncomplicated bone metastases

“…In the Dutch Bone Metastasis Study, however, no difference in pain response was seen in patients surviving more than one year after a single fraction of 8 Gy or fractionated conventional radiotherapy [60]. An analysis of the prospective PRESENT cohort including those patients with oligometastatic bone disease showed higher clinical local control rates after SBRT compared to conventional radiotherapy, but SBRT did not improve pain response, duration of response or quality of life [89]. No difference in pain response was seen after stratification by radiation dose (8 Gy in one fraction vs 30 Gy in 10 fraction vs SBRT).…”