Stereotactic body radiation therapy versus conventional external beam radiotherapy for spinal metastases: A systematic review and meta-analysis of randomized controlled trials

• Published in: Radiotherapy and oncology Vol. 189; p. 109914
• Main Authors: Wong, Henry C.Y., Lee, Shing Fung, Chan, Adrian Wai, Caini, Saverio, Hoskin, Peter, Simone, Charles B., Johnstone, Peter, van der Linden, Yvette, van der Velden, Joanne M., Martin, Emily, Alcorn, Sara, Johnstone, Candice, Isabelle Choi, J., Nader Marta, Gustavo, Oldenburger, Eva, Raman, Srinivas, Rembielak, Agata, Vassiliou, Vassilios, Bonomo, Pierluigi, Nguyen, Quynh-Nhu, Chow, Edward, Ryu, Samuel
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-12-2023
• Subjects: Bone Neoplasms/secondary; Conformal; Meta-Analysis; Pain Management; Radiotherapy; Stereotactic Body Radiation Therapy; Stereotactic Body Radiation Therapy; Conformal; Meta-Analysis; Radiotherapy; Bone Neoplasms/secondary; Pain Management
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2023.109914

•Spine metastases can result in debilitating pain and neurological complications.•SBRT does not provide better overall pain response compared to cEBRT.•Complete pain response may be better with SBRT compared to cEBRT.•Spine SBRT is safe and has similar side effect profile compared to cEBRT.•Further studies are needed to determine which patients benefit most from spine SBRT.
This study aimed to compare SBRT and cEBRT for treating spinal metastases through a systematic review and meta-analysis of randomized controlled trials (RCTs).
PubMed, EMBASE and Cochrane Library were searched up to 6 May 2023 for RCTs comparing SBRT and cEBRT for spinal metastases. Overall and complete pain response, local progression, overall survival, quality of life and adverse events were extracted. Data were pooled using random-effects models. Results were reported as risk ratios (RRs) for dichotomous outcomes, and hazard ratios (HRs) for time-to-event outcomes, along with their 95% confidence intervals (CIs). Heterogeneity was evaluated using the I2 statistic.
Three RCTs were identified involving 642 patients. No differences were seen in overall pain response comparing SBRT and cEBRT (RR at 3 months: 1.12, 95% CI, 0.74–1.70, p = 0.59; RR at 6 months: 1.29, 95% CI, 0.97–1.72, p = 0.08). Only two of three studies presented complete pain response data. SBRT demonstrated a statistically significant improvement in complete pain response compared to cEBRT (RR at 3 months: 2.52; 95% CI, 1.58–4.01; P < 0.0001; RR at 6 months: 2.48; 95% CI, 1.23–4.99; P = 0.01). There were no significant differences in local progression and overall survival. Adverse events were similar, except for any grade radiation dermatitis, which was significantly lower in SBRT arm (RR 0.17, 95% CI 0.03–0.96, P = 0.04).
SBRT is a safe treatment option for spine metastases. It may provide better complete pain response compared to cEBRT. Additional trials are needed to determine the potential benefits of SBRT in specific patient subsets.