Comparative Analysis of Stereotactic Radiation Therapy and Conventional Radiation Therapy in Cancer Pain Control: A Systematic Review and Meta-Analysis

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) Vol. 36; no. 7; pp. 452 - 462
• Main Authors: Tariq, U.B., Naseer Khan, M.A., Barkha, F.N.U., Sagar, R.S., Suchwani, D., Abdelsamad, O., Bhatt, D., Shakil, G., Rasool, S., Subedi, S., Versha, F.N.U., Bhatia, V., Kumar, S., Khatri, M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2024
• Subjects: Bone Neoplasms - complications; Bone Neoplasms - radiotherapy; Bone Neoplasms - secondary; Cancer Pain - etiology; Cancer Pain - radiotherapy; Comparative effectiveness; conventional radiation therapy; Humans; meta-analysis; metastatic malignant pain; pain management; Pain Management - methods; Radiosurgery - methods; radiotherapeutic approaches; Stereotactic radiotherapy; systematic review; conventional radiation therapy; Comparative effectiveness; meta-analysis; radiotherapeutic approaches; pain management; systematic review; metastatic malignant pain; Stereotactic radiotherapy
• ISSN: 0936-6555; 1433-2981; 1433-2981
• DOI: 10.1016/j.clon.2024.04.004

Approximately 55% of patients diagnosed with primary or metastatic cancer endure pain directly attributable to the disease. Consequently, it becomes imperative to address pain management through a comparative analysis of stereotactic radiotherapy (SRT) and conventional radiation therapy (CRT), especially in light of the less efficacious improvement achieved solely through pharmacological interventions.
A systematic exploration was undertaken on PubMed, the Cochrane Library, and Elsevier's ScienceDirect databases to identify studies that compare Stereotactic Radiotherapy to Conventional radiation therapy for pain management in individuals with metastatic bone cancer. The analyses were executed utilizing the random-effects model.
A cohort of 1152 participants with metastatic bone cancer was analyzed, demonstrating significantly higher complete pain relief in the Stereotactic Radiotherapy group during both early and late follow-up (RR: 1.61; 95% CI: 1.17, 2.23, p-value: 0.004; I2: 0%). Stereotactic Radiotherapy also showed a non-significant increase in the incidence of partial pain relief (RR: 1.07; 95% CI: 0.85, 1.34, p-value: 0.56; I2: 18%). Furthermore, Stereotactic Radiotherapy was associated with a significantly reduced risk of stationary pain throughout follow-up (RR: 0.61; 95%CI: 0.48, 0.76, p-value: <0.0001; I2: 0. The incidence of progressive pain was non-significantly reduced with Stereotactic Radiotherapy during both early and late follow-up (RR: 0.77; 95% CI: 0.50, 1.17, p-value: 0.22; I2: 0%). Secondary outcomes exhibited a non-significant trend favoring Stereotactic Radiotherapy for dysphagia, esophagitis, pain, and radiodermatitis, while a non-significant increase was observed for nausea, fatigue, and vertebral compression fracture.
In summary, stereotactic radiation therapy (SRT) has improved in achieving complete pain relief while exhibiting a decreased probability of delivering stationary pain compared to conventional radiation therapy (CRT). Nevertheless, it is crucial in future research to address a noteworthy limitation, specifically, the risk of vertebral compression fracture.
•SRT demonstrated higher rates of complete pain relief in early and late follow-ups.•Non-significant differences in partial pain relief incidence were seen with SRT.•SRT significantly reduced the risk of stationary pain throughout follow-up.•Non-significant differences in pain progression risk were observed with SRT.