A critical appraisal of the four systematic reviews and meta- analysis on stereotactic body radiation therapy versus external beam radiotherapy for painful bone metastases and where we go from here
Authors
Wong, H. C. Y.Chan, A. W.
Johnstone, P.
Simone, C. B., 2nd
Navarro-Domenech, I.
Hoskin, P.
Johnstone, C.
Recht, A.
Menten, J.
van der Linden, Y. M.
van der Velden, J. M.
Nguyen, Q. N.
Lutz, S.
Andratschke, N.
Wilmann, J.
Kazmierska, J.
Spalek, M.
Lim, F.
Yu, H. M.
Perez, B.
Marta, G. N.
Vassiliou, V.
Lee, S. F.
Bonomo, P.
Rembielak, Agata
Chow, E.
Oldenburger, E.
Raman, S.
Affiliation
Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, ChinaIssue Date
2023
Metadata
Show full item recordAbstract
Radiotherapy is an important treatment modality for pain control in patients with bone metastases. Stereotactic body radiation therapy (SBRT), which allows delivering a much higher dose per fraction while sparing critical structures compared to conventional external beam radiotherapy (cEBRT), has become more widely used, especially in the oligometastatic setting. Randomized controlled trials (RCTs) comparing the pain response rate of SBRT and cEBRT for bone metastases have shown conflicting results, as have four recent systematic reviews with meta-analyses of these trials. Possible reasons for the different outcomes between these reviews include differences in methodology, which trials were included, and the endpoints examined and how they were defined. We suggest ways to improve analysis of these RCTs, particularly performing an individual patient-level meta-analysis since the trials included heterogeneous populations. The results of such studies will help guide future investigations needed to validate patient selection criteria, optimize SBRT dose schedules, include additional endpoints (such as the time to onset of pain response, durability of pain response, quality of life (QOL), and side effects of SBRT), and better assess the cost-effectiveness and trade-offs of SBRT compared to cEBRT. An international Delphi consensus to guide selection of optimal candidates for SBRT is warranted before more prospective data is available.Citation
Wong HCY, Chan AW, Johnstone P, Simone CB, 2nd, Navarro-Domenech I, Hoskin P, et al. A critical appraisal of the four systematic reviews and meta- analysis on stereotactic body radiation therapy versus external beam radiotherapy for painful bone metastases and where we go from here. Annals of palliative medicine. 2023 Jun 2. PubMed PMID: 37303218. Epub 2023/06/12. eng.Journal
Annals of Palliative MedicineDOI
10.21037/apm-23-218PubMed ID
37303218Additional Links
https://dx.doi.org/10.21037/apm-23-218Type
ArticleLanguage
enae974a485f413a2113503eed53cd6c53
10.21037/apm-23-218