Stereotactic body radiotherapy versus conventional external beam radiotherapy for bone metastases: a meta-analysis.
Marc Boutros, Jean-Pierre Saad, Guy Awad et al.
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In 30 seconds
This systematic review and meta-analysis compared stereotactic body radiotherapy (SBRT) with conventional external beam radiotherapy (cEBRT) for painful bone metastases, pooling comparative clinical studies using random-effects models. Early pain reduction, opioid use, and safety outcomes were similar. At 6 months, SBRT was associated with a higher complete pain response (RR = 1.43; p = 0.001) and less progressive pain response (RR = 0.61; p = 0.03). It was also associated with less local progression or treatment failure at 8 months and less re-irradiation at 12 months. One-year overall survival did not differ significantly.
Key findings
- Complete pain response at 6 months was higher with SBRT (RR = 1.43; p = 0.001), while progressive pain response was lower (RR = 0.61; p = 0.03).
- Local progression or treatment failure at 8 months was lower with SBRT (RR = 0.36; p < 0.001).
- Re-irradiation at 12 months was less frequent with SBRT (RR = 0.13; p < 0.001).
- Fractures, spinal cord compression, treatment-related toxicity, and overall survival at 1 year did not differ significantly between modalities.
Why it matters
The findings distinguish early palliation from durability: both approaches had comparable early pain and opioid outcomes, while SBRT was associated with better mid-term pain response and local control. These outcomes can inform discussions about treatment goals and the trade-offs between symptom relief and sustained control, while the absence of significant safety differences provides relevant comparative context.
What to keep in mind
The abstract does not report the number of included studies or participants, and pooled estimates combine comparative studies with potentially varying treatment regimens and clinical endpoints.