Lancet Oncol: Stereotactic radiotherapy can more effectively relieve the pain of patients with spinal metastases than conventional external radiotherapy

Conventional external beam radiation therapy is the standard palliative treatment for spinal metastases; however, the complete pain relief rate of conventional external beam radiation therapy is as low as 10-20%
.

Stereotactic radiotherapy can provide high-dose ablation radiotherapy

The complete pain relief rate of conventional external radiotherapy is as low as 10-20%

This is an open-label, multi-center, randomized controlled Phase 2/3 trial conducted in 18 hospitals in Canada and Australia.
It recruited painful, MRI-clear treatment volumes of no more than 3 consecutive vertebrae at 18 years of age or older.
Patients with spinal metastases in the spine were randomly divided into two groups 1:1, and received stereotactic radiotherapy (24 Gy, two days) or conventional external beam radiotherapy (20 Gy, 5 days)
.

The primary endpoint was the proportion of patients who achieved pain relief 3 months after radiotherapy

From January 4, 2016 to September 27, 2019, a total of 229 patients were recruited and randomly assigned to the conventional external beam radiotherapy group (n=115) or stereotactic radiotherapy group (n=114)
.

All 229 patients were included in the intent-to-treat population analysis

Treatment prognosis

Treatment prognosis

The median follow-up was 6.
7 months (IQR 6.
3-6.
9)
.

At 3 months, 40 out of 114 patients (35%) in the stereotactic radiotherapy group achieved complete pain relief, and 16 out of 115 patients in the conventional external beam radiation therapy group (14%) achieved complete pain relief (risk Ratio 1.

At 3 months, 40 of the 114 patients (35%) in the stereotactic radiotherapy group achieved complete pain relief, and 16 of the 115 patients in the conventional external beam radiation therapy group (14%) achieved complete pain relief

Adverse events

Adverse events

The most common grade 3-4 adverse events were grade 3 pain (4% in the conventional group and 5% in the stereotactic group)
.

There were no treatment-related deaths

The most common grade 3-4 adverse events are grade 3 pain (4% in the routine group, 5% in the stereotactic group)

In summary, for patients with spinal metastases, stereotactic radiotherapy (24 Gy, divided into two days, 1 time/day) is better than conventional external beam radiation therapy (20 Gy, divided into 5 days, 1 Times/day)
.

This study shows that conformal, image-guided, stereotactic dose-escalation radiotherapy is suitable for palliative care to control the symptoms of patients with specific painful spinal metastases

For metastatic spinal tumors, stereotactic radiotherapy (24 Gy, two days, once / day) is superior in increasing pain complete remission rates of conventional external beam radiotherapy (20 Gy, in 5 days, once / day) for For patients with spinal metastases, stereotactic radiotherapy (24 Gy, divided into two days, 1 time/day) is superior to conventional external beam radiation therapy (20 Gy, divided into 5 days, 1 time/day) in improving the rate of complete pain relief

Original source:

Original source:

Arjun Sahgal, et al.

Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trial in this message