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- Title
Stereotactic Body and Conventional Radiotherapy for Painful Bone Metastases: A Systematic Review and Meta-Analysis.
- Authors
Bindels, Bas J. J.; Mercier, Carole; Gal, Roxanne; Verlaan, Jorrit-Jan; Verhoeff, Joost J. C.; Dirix, Piet; Ost, Piet; Kasperts, Nicolien; van der Linden, Yvette M.; Verkooijen, Helena M.; van der Velden, Joanne M.
- Abstract
Key Points: Question: Is stereotactic body radiotherapy (SBRT) associated with superior relief of metastatic bone pain compared with conventional external beam radiotherapy (cEBRT)? Findings: In this systematic review and meta-analyses of 8 randomized clinical trials and 1090 patients, the overall pain response did not differ between patients treated with cEBRT and SBRT after 1, 3, or 6 months. More patients experienced complete pain alleviation after SBRT than after cEBRT at all 3 time points. Meaning: This systematic review and meta-analysis does not support the routine use of SBRT for all patients with painful bone metastases, but selected subgroups may benefit from SBRT. This systematic review and meta-analysis assesses the comparative effectiveness associated with stereotactic body radiotherapy vs conventional external beam radiotherapy for relief of metastatic bone pain. Importance: Conventional external beam radiotherapy (cEBRT) and stereotactic body radiotherapy (SBRT) are commonly used treatment options for relieving metastatic bone pain. The effectiveness of SBRT compared with cEBRT in pain relief has been a subject of debate, and conflicting results have been reported. Objective: To compare the effectiveness associated with SBRT vs cEBRT for relieving metastatic bone pain. Data Sources: A structured search was performed in the PubMed, Embase, and Cochrane databases on June 5, 2023. Additionally, results were added from a new randomized clinical trial (RCT) and additional unpublished data from an already published RCT. Study Selection: Comparative studies reporting pain response after SBRT vs cEBRT in patients with painful bone metastases. Data Extraction and Synthesis: Two independent reviewers extracted data from eligible studies. Data were extracted for the intention-to-treat (ITT) and per-protocol (PP) populations. The study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures: Overall and complete pain response at 1, 3, and 6 months after radiotherapy, according to the study's definition. Relative risk ratios (RRs) with 95% CIs were calculated for each study. A random-effects model using a restricted maximum likelihood estimator was applied for meta-analysis. Results: There were 18 studies with 1685 patients included in the systematic review and 8 RCTs with 1090 patients were included in the meta-analysis. In 7 RCTs, overall pain response was defined according to the International Consensus on Palliative Radiotherapy Endpoints in clinical trials (ICPRE). The complete pain response was reported in 6 RCTs, all defined according to the ICPRE. The ITT meta-analyses showed that the overall pain response rates did not differ between cEBRT and SBRT at 1 (RR, 1.14; 95% CI, 0.99-1.30), 3 (RR, 1.19; 95% CI, 0.96-1.47), or 6 (RR, 1.22; 95% CI, 0.96-1.54) months. However, SBRT was associated with a higher complete pain response at 1 (RR, 1.43; 95% CI, 1.02-2.01), 3 (RR, 1.80; 95% CI, 1.16-2.78), and 6 (RR, 2.47; 95% CI, 1.24-4.91) months after radiotherapy. The PP meta-analyses showed comparable results. Conclusions and Relevance: In this systematic review and meta-analysis, patients with painful bone metastases experienced similar overall pain response after SBRT compared with cEBRT. More patients had complete pain alleviation after SBRT, suggesting that selected subgroups will benefit from SBRT.
- Subjects
CANCER pain; ONLINE information services; MEDICAL databases; META-analysis; MEDICAL information storage &; retrieval systems; CONFIDENCE intervals; METASTASIS; BONE tumors; TREATMENT effectiveness; DESCRIPTIVE statistics; RADIOTHERAPY; DATA analysis software; MEDLINE; DISEASE complications
- Publication
JAMA Network Open, 2024, Vol 7, Issue 2, pe2355409
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.55409