TY - JOUR
T1 - Stereotactic body radiation therapy versus conventional external beam radiotherapy for spinal metastases
T2 - A systematic review and meta-analysis of randomized controlled trials
AU - Wong, Henry C.Y.
AU - Lee, Shing Fung
AU - Chan, Adrian Wai
AU - Caini, Saverio
AU - Hoskin, Peter
AU - Simone, Charles B.
AU - Johnstone, Peter
AU - van der Linden, Yvette
AU - van der Velden, Joanne M.
AU - Martin, Emily
AU - Alcorn, Sara
AU - Johnstone, Candice
AU - Isabelle Choi, J.
AU - Nader Marta, Gustavo
AU - Oldenburger, Eva
AU - Raman, Srinivas
AU - Rembielak, Agata
AU - Vassiliou, Vassilios
AU - Bonomo, Pierluigi
AU - Nguyen, Quynh Nhu
AU - Chow, Edward
AU - Ryu, Samuel
N1 - Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/12
Y1 - 2023/12
N2 - Introduction: This study aimed to compare SBRT and cEBRT for treating spinal metastases through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: 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. Results: 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). Conclusion: 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.
AB - Introduction: This study aimed to compare SBRT and cEBRT for treating spinal metastases through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: 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. Results: 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). Conclusion: 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.
KW - Bone Neoplasms/secondary
KW - Conformal
KW - Meta-Analysis
KW - Pain Management
KW - Radiotherapy
KW - Stereotactic Body Radiation Therapy
UR - http://www.scopus.com/inward/record.url?scp=85173136187&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2023.109914
DO - 10.1016/j.radonc.2023.109914
M3 - Review article
C2 - 37739318
AN - SCOPUS:85173136187
SN - 0167-8140
VL - 189
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
M1 - 109914
ER -