A critical appraisal of the four systematic reviews and meta-analysis on stereotactic body radiation therapy versus external beam radiotherapy for painful bone metastases and where we go from here.

Autor: Wong HCY; Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China., Chan AW; Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China., Johnstone P; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA., Simone CB 2nd; Department of Radiation Oncology, New York Proton Center, New York, NY, USA., Navarro-Domenech I; Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada., Hoskin P; Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, The University of Manchester, UK., Johnstone C; Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA., Recht A; Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA., Menten J; Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium., van der Linden YM; Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands; Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, The Netherlands., van der Velden JM; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands., Nguyen QN; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Lutz S; Eastern Woods Radiation Oncology, Blanchard Valley Health Organization, Findlay, OH, USA., Andratschke N; Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Wilmann J; Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Kazmierska J; Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland; Department of Electroradiology, Poznań University of Medical Sciences, Poznan, Poland., Spalek M; Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland., Lim F; Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China., Yu HM; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA., Perez B; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA., Marta GN; Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil., Vassiliou V; Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus., Lee SF; Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China; Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore., Bonomo P; Department of Oncology, Azienda, Ospedaliero-Universitaria Careggi, Florence, Italy., Rembielak A; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK., Chow E; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada., Oldenburger E; Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium., Raman S; Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
Jazyk: angličtina
Zdroj: Annals of palliative medicine [Ann Palliat Med] 2023 Nov; Vol. 12 (6), pp. 1318-1330. Date of Electronic Publication: 2023 Jun 02.
DOI: 10.21037/apm-23-218
Abstrakt: Radiotherapy is an important treatment modality for pain control in patients with bone metastases. Stereotactic body radiation therapy (SBRT), which allows delivering a much higher dose per fraction while sparing critical structures compared to conventional external beam radiotherapy (cEBRT), has become more widely used, especially in the oligometastatic setting. Randomized controlled trials (RCTs) comparing the pain response rate of SBRT and cEBRT for bone metastases have shown conflicting results, as have four recent systematic reviews with meta-analyses of these trials. Possible reasons for the different outcomes between these reviews include differences in methodology, which trials were included, and the endpoints examined and how they were defined. We suggest ways to improve analysis of these RCTs, particularly performing an individual patient-level meta-analysis since the trials included heterogeneous populations. The results of such studies will help guide future investigations needed to validate patient selection criteria, optimize SBRT dose schedules, include additional endpoints (such as the time to onset of pain response, durability of pain response, quality of life (QOL), and side effects of SBRT), and better assess the cost-effectiveness and trade-offs of SBRT compared to cEBRT. An international Delphi consensus to guide selection of optimal candidates for SBRT is warranted before more prospective data is available.
Databáze: MEDLINE