Update on the Systematic Review of Palliative Radiotherapy Trials for Bone Metastases

Chow, Edward; Zeng, Liang; Salvo, Nadia; Dennis, Kristopher; Tsao, May; Lutz, S

doi:10.1016/j.clon.2011.11.004

Cited by 537 publications

(399 citation statements)

References 30 publications

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“…A meta-analysis of 25 trials found overall and complete pain response rates of 60% (1,696 of 2,818) and 23% (620 of 2,641), respectively, 12 weeks after treatment with a single fraction of 8 Gy. The main primary sites represented in these studies were prostate, breast, and lung [37]. The American Society for Radiation Oncology recommends 8 Gy single-fraction therapy for palliation of metastatic bone pain, because multiple meta-analyses comparing single and multifraction therapy have shown no palliative difference, and single-fraction therapy is less expensive and more convenient for patients [37,43].…”

Section: Uncomplicated Painful Spinal Metastasesmentioning

confidence: 99%

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The Metastatic Spine Disease Multidisciplinary Working Group Algorithms

et al. 2015

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The Metastatic Spine Disease Multidisciplinary Working Group consists of medical and radiation oncologists, surgeons, and interventional radiologists from multiple comprehensive cancer centers who have developed evidence-and expert opinionbased algorithms for managing metastatic spine disease. The purpose of these algorithms is to facilitate interdisciplinary referrals by providing physicians with straightforward recommendations regarding the use of available treatment options, including emerging modalities such as stereotactic body radiation therapy and percutaneous tumor ablation. This consensus document details the evidence supporting the Working Group algorithms and includes illustrative cases to demonstrate how the algorithms may be applied. The Oncologist 2015;20:1205-1215Implications for Practice: The Metastatic Spine Disease Multidisciplinary Working Group algorithms can facilitate interdisciplinary referrals by providing physicians with straightforward recommendations regarding available treatment options, including emerging modalities such as stereotactic body radiation therapy and percutaneous tumor ablation.

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Section: Uncomplicated Painful Spinal Metastasesmentioning

confidence: 99%

“…The rate of pathologic VCF at sites treated with cEBRT is approximately 3% [37]but rangesfrom11% to39% after SBRT with median times to fracture of 2-25 months [38]. However, the benefits of prophylactic vertebral augmentation before or after radiation therapy have not been validated.…”

mentioning

confidence: 99%

The Metastatic Spine Disease Multidisciplinary Working Group Algorithms

et al. 2015

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“…Currently, accepted radiation techniques include a variety of fractionated regimens as well as single fraction treatment, which has historically been delivered at a dose of 8 Gy. Multiple studies have shown these techniques to result in a pain response of approximately 60% 1, 2. More recent data support the use of stereotactic body radiation therapy (SBRT) or radiosurgery for spinal metastases with fewer fractions delivered and greater, more durable responses.…”

Section: Introductionmentioning

confidence: 99%

Single fraction radiosurgery/stereotactic body radiation therapy (SBRT) for spine metastasis: A dosimetric comparison of multiple delivery platforms

Nalichowski

Kaufman

Gallo

et al. 2016

J Applied Clin Med Phys

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There are numerous commercial radiotherapy systems capable of delivering single fraction spine radiosurgery/SBRT. We aim to compare the capabilities of several of these systems to deliver this treatment when following standardized criteria from a national protocol. Four distinct target lesions representing various case presentations of spine metastases were contoured in both the thoracic and lumbar spine of an anthropomorphic SBRT phantom. Single fraction radiosurgery/SBRT plans were designed for each target with each of our treatment platforms. Plans were prescribed to 16 Gy in one fraction to cover 90% of the target volume using normal tissue and target constraints from RTOG 0631. We analyzed these plans with priority on the dose to 10% of the partial spinal cord and dose to 0.03 cc of the spinal cord. Each system was able to maintain 90% target coverage while meeting all the constraints of RTOG 0631. On average, CyberKnife was able to achieve the lowest spinal cord doses overall and also generated the sharpest dose falloff as indicated by the Paddick gradient index. Treatment times varied widely depending on the modality utilized. On average, treatment can be delivered faster with Flattening Filter Free RapidArc and Tomotherapy, compared to Vero and Cyberknife. While all systems analyzed were able to meet the dose constraints of RTOG 0631, unique characteristics of individual treatment modalities may guide modality selection. Specifically, certain modalities performed better than the others for specific target shapes and locations, and delivery time varied significantly among the different modalities. These findings could provide guidance in determining which of the available modalities would be preferable for the treatment of spine metastases based on individualized treatment goals.

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“…Pooled results from 12 phase III trials of conventional external beam radiotherapy showed an 8 % rate of retreatment for lesions previously treated with MF schedules and a 20 % rate for lesions previously treated with SF schedules [5]. An additional recent systematic review and meta-analysis reported a 58 % pain response rate following re-irradiation [35].…”

Section: Recurrent Pain Following Radiotherapymentioning

confidence: 99%

“…Typical schedules include 8 Gy in one fraction, 20 Gy in five fractions, 24 Gy in six fractions and 30 Gy in ten fractions. A recent meta-analysis of 25 trials comparing SF and MF schedules such as these showed similar overall pain response rates of 60 % and 61 %, and complete pain response rates of 23 % and 24 % for SF and MF schedules, respectively [5]. MF schedules had a lower rate of retreatment than SF schedules (8 % vs 20 %), but many contend that the convenience and cost effectiveness of the SF schedule [6], the ability to safely and effectively re-irradiate if necessary, and the durability of the SF pain response [7] especially among patients with shorter life expectancies compensate for this shortcoming [8].…”

Section: Uncomplicated Bone Metastases Causing Painmentioning

confidence: 99%

Management of bone metastases: recent advances and current status

Dennis¹,

Vassiliou²,

Balboni³

et al. 2012

J Radiat Oncol

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This narrative review summarizes new and existing local and systemic management strategies for bone metastases from the fields of radiation oncology, medical oncology and orthopaedic surgery. Local management strategies are organized according to different clinical scenarios, with complicated bone metastases defined as those with associated pathological fractures, soft tissue components or those compressing the spinal cord or cauda equina, and uncomplicated lesions defined as those without these adverse features. The distinction applies for both sclerotic and lytic lesions. Systemic strategies are organized according to classes of therapeutic agents.

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Update on the Systematic Review of Palliative Radiotherapy Trials for Bone Metastases

Cited by 537 publications

References 30 publications

The Metastatic Spine Disease Multidisciplinary Working Group Algorithms

The Metastatic Spine Disease Multidisciplinary Working Group Algorithms

Single fraction radiosurgery/stereotactic body radiation therapy (SBRT) for spine metastasis: A dosimetric comparison of multiple delivery platforms

Management of bone metastases: recent advances and current status

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