Stereotactic body radiotherapy is superior to conventional external beam radiotherapy for improving the complete response rate for pain associated with spinal metastasis, according to a study published online June 11 in The Lancet Oncology.
Arjun Sahgal, M.D., from the University of Toronto, and colleagues compared complete response rates for pain after stereotactic body radiotherapy or conventional external beam radiotherapy in patients with painful spinal metastasis. Patients were randomly assigned to conventional external beam radiotherapy (115 patients; 20 Gy in five daily fractions) or stereotactic body radiotherapy (114 patients; 24 Gy in two daily fractions).
The researchers found that at three months, 35 percent of patients in the stereotactic body radiotherapy group and 14 percent of patients in the conventional external beam radiotherapy group had a complete response for pain (risk ratio, 1.33), which remained significant in multivariable-adjusted analyses (odds ratio 3.47). There were no treatment-related deaths, but the most common grade 3 to 4 adverse event was grade 3 pain (five patients in each group).
“These results suggest that use of conformal, image-guided, stereotactically dose-escalated radiotherapy is appropriate in the palliative setting for symptom control for selected patients with painful spinal metastases, and an increased awareness of the need for specialized and multidisciplinary involvement in the delivery of end-of-life care is needed,” the authors write.