Replacing 30 Gy in 10 fractions with stereotactic body radiation therapy for bone metastases: A large multi-site single institution experience 2016–2018

Abstract

Background: Bone metastases cause significant morbidity in patients with cancer, and radiation therapy (RT) is an effective treatment approach. Indications for more complex ablative techniques are emerging. We sought to evaluate RT trends at a large multi-site tertiary cancer center. Methods: Patients who received RT for bone metastases at a single institution (including regional outpatient clinics) from 2016 to 2018 were identified. Patients were grouped by RT regimen: single-fraction conventional RT (8 Gy  1), 30 Gy in 10 fractions, SBRT, and ''other". Multinomial logistic regression was performed to assess trends in regimens over time. Binary logistic regression was performed to evaluate factors associated with receipt of SBRT. Results: Between 2016 and 2018, 5,952 RT episodes were received by 2,969 patients with bone metastases. Overall, 76% of episodes were 5 fractions. The median number of fractions planned for SBRT and non-SBRT episodes was 3 (IQR 3-3) and 5 (IQR 5-10), respectively. Use of SBRT increased from 2016 to 2018 (39% to 53%, p < 0.01) while use of 30 Gy in 10 fractions decreased (26% to 12%, p < 0.01), and 8 Gy  1 was stable (5.3% to 6.9%, p = 0.28). SBRT was associated with higher performance status (p < 0.01) and non-radiosensitive histology (p < 0.01). Use of SBRT increased in the regional network (19% to 48%, p < 0.01) and at the main center (52% to 59%, p = 0.02), but did not increase within 30 days of death. More patients treated with 8 Gy  1 than SBRT died within 30 days of treatment (24% vs 3.8%, respectively, p < 0.01). Conclusions: SBRT is replacing 30 Gy in 10 fractions for bone metastases, especially among patients with high performance status and non-radiosensitive histologies. Better prognostic algorithms could further improve patient-centered treatment selection at the end of life.

Improvement of Metastatic Spinal Cord Compression After Decompression Surgery and Radiotherapy in a Patient Initially Treated for Rectal Cancer

“…Laufer I et al studied 186 patients who underwent SRT after surgery and reported that high-dose prescription could control radiation-resistant tumors that cannot be controlled well with normal dose fractionation [13]. In the future, we believe SRT may also be used for cases of oligometastases or oligo-recurrence [14]. Our patient had a case of rectal cancer with a tumor that was not highly sensitive to radiation.…”

Multidisciplinary Treatment of Non-Spine Bone Metastases: Results of a Modified Delphi Consensus Process

“…In the palliative setting, a phase II randomized controlled trial showed single fraction SBRT to be non-inferior to multi-fraction conventional RT, with higher rates of pain response in those receiving SBRT [57] . We favor using conventional RT for bone metastases in most cases, with SBRT reserved for patients at high risk for recurrence, in particular those with radioresistant tumors or prolonged expected survival [5] .…”

“…While comprehensive multidisciplinary guidelines exist for spinal metastases [2] , national guidelines for the management of non-spine bone metastases have traditionally focused on radiation therapy (RT) to palliate pain, and surgical intervention and bone modifying agents to treat or prevent pathologic fractures [3] , [4] . A recent review showed the most common locations for these lesions include the hip/pelvis, ribs, shoulder, and femur and comprise 46% of all bone metastases treated in a tertiary radiation oncology center [5] . However, as systemic therapies have evolved and options for local therapy have increased, the utility of existing guidelines in routine care is increasingly limited.…”

Quality of life improvement in patients with bone metastases undergoing palliative radiotherapy

“…Nguyen et al [27] found in a phase II trial that SBRT had higher rates of pain response. Indeed, several studies have been published comparing the effectiveness between SBRT and conventional RT [32][33][34][35][36][37]. Indeed, there are potential disadvantages of SBRT, including possible increased pain flare or a higher incidence of radiation-induced fractures [38].…”