There is a growing body of evidence suggesting that SBRT is effective for pain control in a significant proportion of patients after the third month of treatment. This is comparable to conventional radiotherapy pain response rates. In addition, evidence suggest that the use of SBRT is an effective treatment for SREs notwithstanding there still a need of optimization in balance dose/toxicity regimes for SBRT.
From a public health perspective SBRT moves toward clearer trends in terms of its safety and efficacy. However, it is still relevant that further research must be carried out also on identified feasible applications. Since the diversity of applications could impact oncology services in terms of patients treated and time by reducing delivery and recurrences periods. Allowing an increase in the capacity of number of patients treated in the radiology service. Also, transversal to the clinical and technical evaluations for SBRT it is relevant to carry out financial evaluations that allow to quantify its economic impact on oncology departments. Diversification could also address population with high incidence of bone metastasis like Pca patients. SBRT it outlined as reliable treatment specially in oligometastases disease patients. Although pain response could not be the optimal end point for oligometastatic patients. Other end point as delay to systemic therapy like androgen deprivation therapy-free survival could represent a relevant variable to assesses in further phase two and three studies.
References
Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. , 2021.
https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf (Accessed 24 January2021).
Agarwal MG, Nayak P. Management of skeletal metastases: An orthopaedic surgeon's guide.
Indian journal of orthopaedics 2015;49:83-100.
Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, Vrionis FD, Yamada Y, Gerszten PC, Kuklo TR. Reliability analysis of the epidural spinal cord compression scale Clinical article. J NEUROSURG-SPINE 2010;13:324-328.
Chang JH, Gandhidasan S, Finnigan R, Whalley D, Nair R, Herschtal A, Eade T, Kneebone A, Ruben J, Foote M, Siva S. Stereotactic Ablative Body Radiotherapy for the Treatment of Spinal
Oligometastases. Clin Oncol (R Coll Radiol ) 2017;29:e119-e125.
Chow E, Wu JS, Hoskin P, Coia LR, Bentzen SM, Blitzer PH. International consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases. Radiother Oncol
2002;64:275-280.
Coleman R, Hadji P, Body J-, Santini D, Chow E, Terpos E, Oudard S, Bruland Ø, Flamen P, Kurth A, Van Poznak C, Aapro M, Jordan K. Bone health in cancer: ESMO Clinical Practice Guidelines.
Annals of oncology 2020;31:1650-1663.
Coleman RE. Clinical Features of Metastatic Bone Disease and Risk of Skeletal Morbidity. Clin Cancer Res 2006;12:6243s-6249s.
Costelloe CM, Chuang HH, Madewell JE, Ueno NT. Cancer Response Criteria and Bone Metastases: RECIST 1.1, MDA and PERCIST. J Cancer 2010;1:80-92.
Faruqi S, Tseng C, Whyne C, Alghamdi M, Wilson J, Myrehaug S, Soliman H, Lee Y, Maralani P, Yang V, Fisher C, Sahgal A. Vertebral Compression Fracture After Spine Stereotactic Body Radiation Therapy: A Review of the Pathophysiology and Risk Factors. Neurosurgery 2018;83:314-322.
Garcia J. Physics of SBRT/SR. , 2019. https://www.youtube.com/watch?v=WQoSob-eOjM (Accessed 23 January2021).
Gerszten PC, Mendel E, Yamada Y. Radiotherapy and radiosurgery for metastatic spine disease:
what are the options, indications, and outcomes? Spine (Philadelphia, Pa.1976); Spine (Phila Pa 1976) 2009;34:S78-S92.
Ghia AJ, Guha-Thakurta N, Hess K, Yang JN, Settle SH, Sharpe HJ, Li J, McAleer M, Chang EL, Tatsui CE, Brown PD, Rhines LD. Phase 1 Study of Spinal Cord Constraint Relaxation With Single Session Spine Stereotactic Radiosurgery in the Primary Management of Patients With Inoperable,
Previously Unirradiated Metastatic Epidural Spinal Cord Compression. Int J Radiat Oncol Biol Phys 2018;102:1481-1488.
Grávalos C, Rodríguez C, Sabino A, Seguí MÁ, Virizuela JA, Carmona A, Cassinello J, Isla D, Jara C, Martín M. SEOM Clinical Guideline for bone metastases from solid tumours (2016). Clinical and Translational Oncology 2016;18:1243-1253.
Gupta T, Jaiprakash A, Banerjee S, Ghosh Laskar S, Murthy V, Budrukkar A. IMRT and IGRT in head and neck cancer: Have we delivered what we promised? Indian journal of surgical oncology 2010;1:166-85.
Haridass A. Developments in Stereotactic Body Radiotherapy. Cancers; Cancers (Basel) 2018;10:497.
Hellman S, Weichselbaum RR. Oligometastases. JCO 1995;13:8-10.
Heymann D. Bone Cancer : Primary Bone Cancers and Bone Metastases. San Diego, California ;:
Academic Press 2015.
Highsmith JM. Cancer and Spinal Fractures. , 2019. https://www.spineuniverse.com/resource-center/spinal-fractures/cancer-spinal-fractures. (Accessed February 2021).
International Atomic Energy Agency, (IAEA). Radionuclide therapy. , 2021.
https://www.iaea.org/topics/radionuclide-therapy#:~:text=Nuclear%20medicine%20therapy%20uses%20radiopharmaceuticals,mitigate%2 0or%20control%20the%20disease. (Accessed February2021).
Ishigaki T, Ishigaki T, Uruno T, Uruno T, Tanaka T, Tanaka T, Ogimi Y, Ogimi Y, Masaki C, Masaki C, Akaishi J, Akaishi J, Hames K, Hames K, Yabuta T, Yabuta T, Suzuki A, Suzuki A, Tomoda C, Tomoda C, Matsuzu K, Matsuzu K, Ohkuwa K, Ohkuwa K, Kitagawa W, Kitagawa W, Nagahama M,
Nagahama M, Sugino K, Sugino K, Ito K, Ito K. Usefulness of Stereotactic Radiotherapy Using the CyberKnife for Patients with Inoperable Locoregional Recurrences of Differentiated Thyroid Cancer. World J Surg 2019;43:513-518.
Ito K, Furuya T, Shikama N, Nihei K, Tanaka H, Kumazaki Y, Nishimura H, Karasawa K. A
prospective multicentre feasibility study of stereotactic body radiotherapy in Japanese patients with spinal metastases. Jpn J Clin Oncol 2019;49:999-1003.
Ito K, Ogawa H, Shimizuguchi T, Nihei K, Furuya T, Tanaka H, Karasawa K. Stereotactic Body Radiotherapy for Spinal Metastases: Clinical Experience in 134 Cases From a Single Japanese Institution. Technology in Cancer Research & Treatment 2018;17.
Jin J, Chen Q, Jin R, Rock J, Anderson J, Li S, Movsas B, Ryu S. Technical and clinical experience with spine radiosurgery: a new technology for management of localized spine metastases.
Technology in cancer research & treatment 2007;6:127-133.
Joiner M, Kogel Avd. Basic Clinical Radiobiology. Boca Raton ;: CRC Press 2019.
Kim SU, Kim DY, Park JY, Ahn SH, Nah HJ, Chon CY, Han K. Hepatocellular carcinoma presenting with bone metastasis: clinical characteristics and prognostic factors. J Cancer Res Clin Oncol 2008;134:1377-1384.
Lievens Y, Guckenberger M, Gomez D, Hoyer M, Iyengar P, Kindts I, Méndez Romero A, Nevens D, Palma D, Park C, Ricardi U, Scorsetti M, Yu J, Woodward WA. Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document. Radiother Oncol 2020;148:157-166.
Lo S, Slotman B, Lock M, Nagata Y, Guckenberger M, Foote M, Tan D, Teh B, Mayr N, Chang E, Timmerman R, Sahgal A. The development of stereotactic body radiotherapy in the past decade:
a global perspective. Future Oncology 2015;11:2721.
Łukaszewski B, Nazar J, Goch M, Łukaszewska M, Stępiński A, Jurczyk MU. Diagnostic methods for detection of bone metastases. Contemporary oncology (Poznan, Poland) 2017;21:98-103.
Mercier C, Dirix P, Ost P, Billiet C, Joye I, Vermeulen P, Lievens Y, Verellen D. A phase III randomized-controlled, single-blind trial to improve quality of life with stereotactic body radiotherapy for patients with painful bone metastases (ROBOMET). BMC Cancer 2019;19:876.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for
systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-9, W64.
Muresan MM, Olivier P, Leclère J, Sirveaux F, Brunaud L, Klein M, Zarnegar R, Weryha G. Bone metastases from differentiated thyroid carcinoma. Endocr Relat Cancer 2008;15:37-49.
Nguyen Q, Chun SG, Chow E, Komaki R, Liao Z, Zacharia R, Szeto BK, Welsh JW, Hahn SM, Fuller CD, Moon BS, Bird JE, Satcher R, Lin PP, Jeter M, O'Reilly MS, Lewis VO. Single-Fraction
Stereotactic vs Conventional Multifraction Radiotherapy for Pain Relief in Patients With Predominantly Nonspine Bone Metastases: A Randomized Phase 2 Trial. JAMA oncology 2019;5:872-878.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting
P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
BMJ 2021;372:n71.
Pichon B, Campion L, Delpon G, Thillays F, Carrie C, Cellier P, Pommier P, Laude C, Mervoyer A, Hamidou H, Mahé M, Supiot S. High-Dose Hypofractionated Radiation Therapy for
Noncompressive Vertebral Metastases in Combination With Zoledronate: A Phase 1 Study. Int J Radiat Oncol Biol Phys 2016;96:840-847.
Popovic M, Chow R, Lao N, Bedard G, Chow E. Chapter 50 - Pain control with palliative radiotherapy in patients with bone metastases. Bone Cancer (Second Edition). San Diego:
Academic Press; 2015:599-613. Available from:
http://www.sciencedirect.com.ezproxy.uef.fi:2048/science/article/pii/B9780124167216000509.
Redmond KJ, Sciubba D, Khan M, Gui C, Lo SL, Gokaslan ZL, Leaf B, Kleinberg L, Grimm J, Ye X, Lim M. A Phase 2 Study of Post-Operative Stereotactic Body Radiation Therapy (SBRT) for Solid
Tumor Spine Metastases. Int J Radiat Oncol Biol Phys 2020;106:261-268.
Rodrigues G, Velker V, Best L. Radiation Oncology Primer and Review : Essential Concepts and Protocols. New York: Demos Medical Publishing, LLC 2013.
Ryu S, Pugh SL, Gerszten PC, Yin FF, Timmerman RD, Hitchcock YJ, Movsas B, Kanner AA, Berk LB, Followill DS, Kachnic LA. RTOG 0631 phase 2/3 study of image guided stereotactic radiosurgery for localized (1-3) spine metastases: phase 2 results. Pract Radiat Oncol 2014;4:76-81.
Ryu S, Rock J, Jain R, Lu M, Anderson J, Jin J, Rosenblum M, Movsas B, Kim JH. Radiosurgical decompression of metastatic epidural compression. Cancer 2010;116:2250-2257.
Sahgal A, Roberge D, Schellenberg D, Purdie TG, Swaminath A, Pantarotto J, Filion E, Gabos Z, Butler J, Letourneau D, Masucci GL, Mulroy L, Bezjak A, Dawson LA, Parliament M. The Canadian Association of Radiation Oncology scope of practice guidelines for lung, liver and spine
stereotactic body radiotherapy. Clin Oncol (R Coll Radiol) 2012;24:629-639.
Sakr A, Hashem WB, Ebrahim N, Mashhour KN. Randomized Pilot Study of 20 Gy in 5 Fractions versus 27 Gy in 3 Fractions Radiotherapy for Treating Painful Bone Metastases: A Single
Institution Experience. Asian Pacific journal of cancer prevention : APJCP 2020;21:1807-1811.
Sibtain A, Morgan A, MacDougall N. Physics for Clinical Oncology. Oxford ;: Oxford University Press 2012.
Spencer KL, van der Velden, J. M., Wong E, Seravalli E, Sahgal A, Chow E, Verlaan JJ, Verkooijen HM, van der Linden, Y. M. Systematic Review of the Role of Stereotactic Radiotherapy for Bone Metastases. J Natl Cancer Inst 2019;111:1023-1032.
Sprave T, Verma V, Förster R, Schlampp I, Bruckner T, Bostel T, Welte SE, Tonndorf-Martini E, Nicolay NH, Debus J, Rief H. Randomized phase II trial evaluating pain response in patients with spinal metastases following stereotactic body radiotherapy versus three-dimensional conformal radiotherapy. Radiother Oncol 2018a;128:274-282.
Sprave T, Verma V, Förster R, Schlampp I, Hees K, Bruckner T, Bostel T, El Shafie RA, Welzel T, Nicolay NH, Debus J, Rief H. Local response and pathologic fractures following stereotactic body radiotherapy versus three-dimensional conformal radiotherapy for spinal metastases - a
randomized controlled trial. BMC Cancer 2018b;18:859.
van de Ven S, van den Bongard D, Pielkenrood B, Kasperts N, Eppinga W, Peters M, Verkooijen H, van der Velden J. Patient-Reported Outcomes of Oligometastatic Patients After Conventional or Stereotactic Radiation Therapy to Bone Metastases: An Analysis of the PRESENT Cohort. Int J Radiat Oncol Biol Phys 2020;107:39-47.
Vassiliou V, Chow E, Kardamakis D. Bone Metastases : A Translational and Clinical Approach. 2nd ed. Dordrecht: Springer Netherlands 2014.
Wardak Z, Bland R, Ahn C, Xie X, Chason D, Morrill K, Stehel E, Nedzi L, Ding C, Medin P, Boike T, Abdulrahman R, Folkert M, Iyengar P, Kim N, Choy H, Bagley C, Timmerman R. A Phase 2 Clinical Trial of SABR Followed by Immediate Vertebroplasty for Spine Metastases. Int J Radiat Oncol Biol Phys 2019;104:83-89.
Wilke L, Andratschke N, Blanck O, Brunner TB, Combs SE, Grosu A, Moustakis C, Schmitt D, Baus WW, Guckenberger M. ICRU report 91 on prescribing, recording, and reporting of stereotactic treatments with small photon beams. Strahlentherapie und Onkologie 2019;195:193-198.
Witt D, Jaque I, Sepúlveda MI. ENFERMEDAD METASTÁSICA DE LA COLUMNA VERTEBRAL. Revista Médica Clínica Las Condes 2020;31:460-471.
World Health Organization, International Atomic Energy Agency. Technical Specifications of Radiotherapy Equipment for Cancer Treatment. Geneva: World Health Organization 2021.