Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trial

Sahgal, Arjun; Myrehaug, Sten; Siva, Shankar; Masucci, Giuseppina Laura; Maralani, Pejman; Brundage, Michael; Butler, James; Chow, Edward; Fehlings, Michael G.; Foote, M.; Gabos, Zsolt; Greenspoon, Jeffrey; Kerba, Marc; Lee, Young; Liu, Mitchell; Liu, Stanley K.; Thibault, Isabelle; Wong, Rebecca; Hum, Maaike; Ding, Keyue; Parulekar, Wendy R.; Investigators, Trial

doi:10.1016/s1470-2045(21)00196-0

Cited by 210 publications

(219 citation statements)

References 33 publications

Supporting

Mentioning

212

Contrasting

Order By: Relevance

“…Furthermore, there was a signi cant association between single-fraction SBRT and development of PP 26 . The so far published randomized trials comparing SBRT versus conventional RT have not reported the rates of PP 12,27,28 . SPINO group de ned any new or progressive tumor within the epidural space as local progression 13 , but we have recently published a case report showing clear epidural involvement on radiological images after spine SBRT, however, the histological analysis revealed no tumor cells in epidural space 29 .…”

Section: Discussionmentioning

confidence: 99%

“…Randomizing patients with spinal metastases into SBRT and conventional RT groups, this study showed negative results for SBRT arm, as pain control was similar at 3 months between two groups. Finally, the Canadian randomized phase 3 trial compared spine SBRT with 24Gy in two daily fractions with conventional RT at a dose of 20Gy in ve fractions 27 . The SBRT was superior to conventional RT and improved the complete pain response at 3 months.…”

Section: Discussionmentioning

confidence: 99%

“…SBRT is a promising modality to treat bone metastases with locally ablative intent 9 and has been used frequently in daily practice for more than a decade. Nevertheless, the results of prospective randomized trials comparing conventional radiotherapy to SBRT are very recent 10,11,12 . The pain response is the focus of these prospective randomized trials and none of them has reported the radiological response assessment yet.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Response Assessment After Stereotactic Body Radiation Therapy for Spine and Non-spine Bone Metastases: Results From a Single Institutional Study

Correia

Moullet

Cullmann

et al. 2021

Preprint

View full text Add to dashboard Cite

Background The use of stereotactic body radiation therapy (SBRT) for tumor- and pain control in patients with bone metastases is increasing. Here, we report response assessment after bone SBRT using radiological changes through time and clinical examination of patients. MethodsWe analyzed retrospectively the oligo-metastatic/progressive patients with bony lesions treated with SBRT between 12/2008 and 10/2018 in our institution. Radiological data were obtained from imaging modalities used for SBRT planning and follow-up (FU) purposes in PACS and assessed by two independent radiologists blind to the time of treatment. Several radiological changes were described. Radiographic response assessment was classified according to University of Texas MD Anderson Cancer Center criteria. Pain response was captured pre- and >= 6 months post-SBRT.ResultsA total of 35 of the 74 reviewed patients were eligible, presenting 43 bone metastases, with 51.2% (n=22) located in vertebral column. Median age at the time of SBRT was 66 years (range, 38-84), and 77.1% (n=27) were male. Histology was mainly prostate (51.4%, n=18) and breast cancer (14.3%, n=5). Median total radiation dose delivered was 24 Gy (range: 24-42), in three fractions (range: 2-7), prescribed to 70 - 90% isodose-line. After a median FU of 1.8 years (range, 0.1-8.2) for survivors, complete-/ partial response, stable (SD), and progressive disease occurred in 0%, 11.4% (n=4), 68.6% (n=24) and 20.0% (n=7) of the patients respectively. Twenty patients (57.1%) died during the FU time, all from disease progression, yet 70% (n=14) from this population with local SD after SBRT. From patients who were symptomatic and available for FU, almost 50% reported pain reduction after SBRT.ConclusionsEighty percent of the patients showed local control (LC) after SBRT for bone metastases. Pain response was favorable. For more accurate response assessment, comparing current imaging modalities with advanced imaging techniques such as functional MRI and PET-CT is warranted.Trial registrationRetrospectively registered.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Response Assessment After Stereotactic Body Radiation Therapy for Spine and Non-spine Bone Metastases: Results From a Single Institutional Study

Correia

Moullet

Cullmann

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Doses used for patients with intact previously untreated spinal metastases on randomized clinical trials include 16 to 18 Gy in 1 fx and 24 Gy in 2 fx, both of which have a high-dose per fraction, and can be considered in the postoperative setting as well. 40,41 Of the four studies that reported patterns of failure after postoperative SBRT, progression within the epidural space was observed in 65% to 100% of those local failures. 14,15,18,25 This observation signifies the importance of covering the epidural space adequately in the CTV.…”

Section: Treatment Planningmentioning

confidence: 99%

Stereotactic Radiosurgery for Postoperative Spine Malignancy: A Systematic Review and International Stereotactic Radiosurgery Society Practice Guidelines

Faruqi

Chen

Fariselli

et al. 2022

Practical Radiation Oncology

Self Cite

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

“…Spinal SBRT is an important tool to give high doses of radiation to spine metastases with the hope of improving symptoms and preventing progression, which can lead to significant pain and neurologic deficits. A recently published randomized trial demonstrated the superiority of spine SBRT (12 Gy × 2) compared to conventionally fractionated palliative radiation (4 Gy × 5) in controlling pain at 3 and 6 months without increasing toxicity [38]. Durable local control with conventional palliative radiotherapy for soft tissue sarcoma is poor, which may stem from the relatively radioresistant nature of sarcoma histologies.…”

Section: Spinementioning

confidence: 99%

Radiation Therapy in Metastatic Soft Tissue Sarcoma: From Palliation to Ablation

Shah

Yegya-Raman

Jones

et al. 2021

Cancers

View full text Add to dashboard Cite

The management of patients with metastatic cancer is rapidly changing. Historically, radiotherapy was utilized for the treatment of localized disease or for palliation. While systemic therapy remains the mainstay of management for patients with metastatic cancer, radiotherapy is becoming increasingly important not only to palliate symptoms, but also to ablate oligometastatic or oligoprogressive disease and improve local control in the primary site. There is emerging evidence in multiple solid malignancies that patients with low volume metastatic disease that undergo local ablative therapy to metastatic sites may have improved progression free survival and potentially overall survival. In addition, there is increasing evidence that select patients with metastatic disease may benefit from aggressive treatment of the primary site. Patients with metastatic soft tissue sarcoma have a poor overall prognosis. However, there may be opportunities in patients with low volume metastatic soft tissue sarcoma to improve outcomes with local therapy including surgery, ablation, embolization, and radiation therapy. Stereotactic body radiation therapy (SBRT) offers a safe, convenient, precise, and non-invasive option for ablation of sites of metastases. In this review article, we explore the limited yet evolving role of radiotherapy to metastatic and primary sites for local control and palliation, particularly in the oligometastatic setting.

show abstract

Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trial

Cited by 210 publications

References 33 publications

Response Assessment After Stereotactic Body Radiation Therapy for Spine and Non-spine Bone Metastases: Results From a Single Institutional Study

Response Assessment After Stereotactic Body Radiation Therapy for Spine and Non-spine Bone Metastases: Results From a Single Institutional Study

Stereotactic Radiosurgery for Postoperative Spine Malignancy: A Systematic Review and International Stereotactic Radiosurgery Society Practice Guidelines

Radiation Therapy in Metastatic Soft Tissue Sarcoma: From Palliation to Ablation

Contact Info

Product

Resources

About