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Impact of recent clinical trials on meta-analysis of stereotactic body radiation therapy for spine metastases and urgent call for consistent study endpoints

Wong, H. C. Y.
; 
Lee, S. F.
; 
Ryu, S.
; 
Chan, A. W.
; 
Caini, S.
; 
Johnstone, P.
; 
van der Linden, Y.
; 
van der Velden, J. M.
; 
Martin, E.
; 
Alcorn, S.
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Abstract
Pain from spinal metastases can result in significant impact to patients' quality of life. Conventional external beam radiation therapy (cEBRT) has long been shown to be effective in the pain control of patients with spinal metastases. With the advancement in radiation therapy, stereotactic body radiation therapy (SBRT) has been increasingly adopted for the treatment of spinal metastases. Multiple randomised controlled trials (RCT) have been performed to evaluate whether SBRT provides better pain relief compared to cEBRT. Previous meta-analyses showed that SBRT have significantly better complete pain response at 3 months compared to cEBRT. This report updates meta-analyses by incorporating the complete pain response data obtained from personal communication with the NRG Oncology Radiation Therapy Oncology Group (RTOG) 0631 principal investigator and the recently published RCT by Guckenberger et al. The results demonstrate that the results for complete pain response at 3 months have now changed and no longer favour SBRT. It is postulated that inconsistent definitions and reporting of study endpoints, specifically regarding vertebral compression fractures induced by radiation therapy, could be possible reasons for the difference in meta-analyses results. A consensus for standardizing study endpoints for future clinical trials in SBRT for painful bone metastases is needed to allow for better interpretation of study results.
Authors
Wong, H. C. Y.
Lee, S. F.
Ryu, S.
Chan, A. W.
Caini, S.
Johnstone, P.
van der Linden, Y.
van der Velden, J. M.
Martin, E.
Alcorn, S.
Johnstone, C.
Choi, J. I.
Marta, G. N.
Oldenburger, E.
Raman, S.
Rembielak, A.
Vassiliou, V.
Bonomo, P.
Nguyen, Q. N.
Tse, S.
Hoskin, P. J.
Simone, C. B., 2nd
Affiliation
Department of Oncology, Princess Margaret Hospital, Hong Kong, China. Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore. Department of Radiation Oncology, Stony Brook University Hospital, New York, NY, USA. Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China. Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy. Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands; Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, The Netherlands. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, LA, USA. Department of Radiation Oncology, University of Minnesota Medical Center, Minneapolis, MN, USA. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA. New York Proton Center, New York, NY, USA; Memorial Sloan Kettering Cancer Center, New York, NY, USA. Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Latin America Cooperative Oncology Group (LACOG), Brazil. Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium. Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada. Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK. Bank of Cyprus Oncology Centre, Department of Radiation Oncology, Nicosia, Cyprus. Department of Radiation Oncology, Azienda, Ospedaliero-Universitaria Careggi, Florence, Italy. Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA. Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China. Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Mount Vernon Cancer Centre, Northwood, UK.
Description
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2025
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Wong HCY, Lee SF, Ryu S, Chan AW, Caini S, Johnstone P, et al. Impact of recent clinical trials on meta-analysis of stereotactic body radiation therapy for spine metastases and urgent call for consistent study endpoints. Annals of palliative medicine. 2025 Mar;14(2):155-9. PubMed PMID: 40211741. Epub 2025/04/11. eng.
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https://christie.openrepository.com/handle/10541/627818
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