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Efficacy and safety of SBRT for spine metastases : A systematic review and meta-analysis for preparation of an ESTRO practice guideline

Guninski, R. S. ; Cuccia, F. ; Alongi, F. ; Andratschke, N. ; Belka, C. ; Bellut, D. ; Dahele, M. ; Josipovic, M. ; Kroese, T. E. and Mancosu, P. , et al. (2023) In Radiotherapy and Oncology
Abstract

Background and purpose: Advances in characterizing cancer biology and the growing availability of novel targeted agents and immune therapeutics have significantly changed the prognosis of many patients with metastatic disease. Palliative radiotherapy needs to adapt to these developments. In this study, we summarize the available evidence for stereotactic body radiotherapy (SBRT) in the treatment of spinal metastases. Materials and methods: A systematic review and meta-analysis was performed using PRISMA methodology, including publications from January 2005 to September 2021, with the exception of the randomized phase III trial RTOG-0631 which was added in April 2023. Re-irradiation was excluded. For meta-analysis, a random-effects model... (More)

Background and purpose: Advances in characterizing cancer biology and the growing availability of novel targeted agents and immune therapeutics have significantly changed the prognosis of many patients with metastatic disease. Palliative radiotherapy needs to adapt to these developments. In this study, we summarize the available evidence for stereotactic body radiotherapy (SBRT) in the treatment of spinal metastases. Materials and methods: A systematic review and meta-analysis was performed using PRISMA methodology, including publications from January 2005 to September 2021, with the exception of the randomized phase III trial RTOG-0631 which was added in April 2023. Re-irradiation was excluded. For meta-analysis, a random-effects model was used to pool the data. Heterogeneity was assessed with the I2-test, assuming substantial and considerable as I2 > 50 % and I2 > 75 %, respectively. A p-value < 0.05 was considered statistically significant. Results: A total of 69 studies assessing the outcomes of 7236 metastases in 5736 patients were analyzed. SBRT for spine metastases showed high efficacy, with a pooled overall pain response rate of 83 % (95 % confidence interval [CI] 68 %-94 %), pooled complete pain response of 36 % (95 % CI: 20 %-53 %), and 1-year local control rate of 94 % (95 % CI: 86 %-99 %), although with high levels of heterogeneity among studies (I2 = 93 %, I2 = 86 %, and 86 %, respectively). Furthermore, SBRT was safe, with a pooled vertebral fracture rate of 9 % (95 % CI: 4 %-16 %), pooled radiation induced myelopathy rate of 0 % (95 % CI 0–2 %), and pooled pain flare rate of 6 % (95 % CI: 3 %-17 %), although with mixed levels of heterogeneity among the studies (I2 = 92 %, I2 = 0 %, and 95 %, respectively). Only 1.7 % of vertebral fractures required surgical stabilization. Conclusion: Spine SBRT is characterized by a favorable efficacy and safety profile, providing durable results for pain control and disease control, which is particularly relevant for oligometastatic patients.

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organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
Oligometastases, SBRT, Spine
in
Radiotherapy and Oncology
article number
109969
publisher
Elsevier
external identifiers
  • pmid:37922993
  • scopus:85177045273
ISSN
0167-8140
DOI
10.1016/j.radonc.2023.109969
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2023 The Authors
id
451c5cba-92dc-4814-aa79-4cbb6db152ed
date added to LUP
2024-01-10 11:08:00
date last changed
2024-04-25 08:05:20
@article{451c5cba-92dc-4814-aa79-4cbb6db152ed,
  abstract     = {{<p>Background and purpose: Advances in characterizing cancer biology and the growing availability of novel targeted agents and immune therapeutics have significantly changed the prognosis of many patients with metastatic disease. Palliative radiotherapy needs to adapt to these developments. In this study, we summarize the available evidence for stereotactic body radiotherapy (SBRT) in the treatment of spinal metastases. Materials and methods: A systematic review and meta-analysis was performed using PRISMA methodology, including publications from January 2005 to September 2021, with the exception of the randomized phase III trial RTOG-0631 which was added in April 2023. Re-irradiation was excluded. For meta-analysis, a random-effects model was used to pool the data. Heterogeneity was assessed with the I<sup>2</sup>-test, assuming substantial and considerable as I<sup>2</sup> &gt; 50 % and I<sup>2</sup> &gt; 75 %, respectively. A p-value &lt; 0.05 was considered statistically significant. Results: A total of 69 studies assessing the outcomes of 7236 metastases in 5736 patients were analyzed. SBRT for spine metastases showed high efficacy, with a pooled overall pain response rate of 83 % (95 % confidence interval [CI] 68 %-94 %), pooled complete pain response of 36 % (95 % CI: 20 %-53 %), and 1-year local control rate of 94 % (95 % CI: 86 %-99 %), although with high levels of heterogeneity among studies (I<sup>2</sup> = 93 %, I<sup>2</sup> = 86 %, and 86 %, respectively). Furthermore, SBRT was safe, with a pooled vertebral fracture rate of 9 % (95 % CI: 4 %-16 %), pooled radiation induced myelopathy rate of 0 % (95 % CI 0–2 %), and pooled pain flare rate of 6 % (95 % CI: 3 %-17 %), although with mixed levels of heterogeneity among the studies (I<sup>2</sup> = 92 %, I<sup>2</sup> = 0 %, and 95 %, respectively). Only 1.7 % of vertebral fractures required surgical stabilization. Conclusion: Spine SBRT is characterized by a favorable efficacy and safety profile, providing durable results for pain control and disease control, which is particularly relevant for oligometastatic patients.</p>}},
  author       = {{Guninski, R. S. and Cuccia, F. and Alongi, F. and Andratschke, N. and Belka, C. and Bellut, D. and Dahele, M. and Josipovic, M. and Kroese, T. E. and Mancosu, P. and Minniti, G. and Niyazi, M. and Ricardi, U. and Munck af Rosenschold, P. and Sahgal, A. and Tsang, Y. and Verbakel, W. F.A.R. and Guckenberger, M.}},
  issn         = {{0167-8140}},
  keywords     = {{Oligometastases; SBRT; Spine}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Radiotherapy and Oncology}},
  title        = {{Efficacy and safety of SBRT for spine metastases : A systematic review and meta-analysis for preparation of an ESTRO practice guideline}},
  url          = {{http://dx.doi.org/10.1016/j.radonc.2023.109969}},
  doi          = {{10.1016/j.radonc.2023.109969}},
  year         = {{2023}},
}