Bone is a common site for metastasis in advanced cancer, often leading to debilitating pain, and is a major cause of morbidity, impaired mobility, pathologic fractures, spinal cord compression and bone marrow aplasia. The cumulative incidence of bone metastasis across all cancer histologies is approximately 12% at 10 years, with a relative incidence ranging from 20-40% for renal cell carcinoma and melanoma to 65-75% in breast cancer and prostate cancer patients.
Treatment paradigms have shifted over the last 5 years with modern targeted agents and immunotherapy allowing many patients to live longer with metastatic disease. Importantly, improving the durability of pain control is important to preserving quality of life in these patients. The standard of care for painful bone metastasis is single or multi fraction conventional palliative radiation (CRT) ranging from 8 Gy x1 fraction to 30 Gy in 10 fractions. Practice patterns vary on the length of treatment for patients and shorter treatments are less burdensome on the patient’s quality of life. Compared to conventional palliative radiation stereotactic body radiation therapy delivers a higher ablative radiation dose. It is hypothesized this will translate into improved local control and durable pain control.
A phase II non-inferiority trial comparing single fraction Stereotactic Body Radiotherapy (SBRT) (12 to 16 Gy x1) to CRT (30 Gy in 10 fractions) demonstrated more durable pain response at 9 months 77% (SBRT) vs 46% (CRT) (p=0.04). Overall survival did not differ. Local progression-free survival was improved with the SBRT 100% vs 90.5% in the CRT at 1 year and 2 years 100% SBRT vs 75.6% in CRT group (p=0.01). No differences were noted in acute and late toxicities. In addition, the SAFFRON meta-analysis of SBRT for spine metastasis demonstrated a significant local control benefit compared to conventional RT.
Therefore, novel applications of SBRT for bone metastasis are needed to continue to improve long-term outcomes for metastatic cancer patients. However, the problem is that the use of SBRT for bone metastasis (spine and non-spine) is not currently considered the standard of care and is used only for well-selected patients.
The aim is to collect original manuscripts, which address novel uses of SBRT for bone metastasis to continue to increase the amount of evidence supporting the use of SBRT. We will also collect review articles from content experts to address the current state of the literature and future directions. The below will be considered:
- Stereotactic body radiation (SBRT) for painful bone metastasis - Long term outcomes from SBRT bone metastasis studies, QOL, pain response and narcotic use following SBRT
- Novel applications of SBRT for spine metastasis - High number of boney sites or vertebral body lengths, circumferential tumor involvement (around an OAR example cord or nerve root), combination of surgery and SBRT, patterns of failure in the sacrum/iliac bones, improve target definition
- SBRT for oligometastasis
- SBRT for oligoprogression
- Combination of SBRT with Laser interstitial therapy (LITT)
- Novel imaging for SBRT target definition
- Serum biomarkers of tumor response
- Imaging biomarkers of tumor progression vs radiation treatment effect - MRI imaging (perfusion imaging), PET imaging
- The use of SBRT for non-spine bone metastasis
- The use of SBRT for spine metastasis
- The combination of LITT and SBRT for spine metastasis
- The use of imaging for treatment and monitoring response for bone metastasis
Bone is a common site for metastasis in advanced cancer, often leading to debilitating pain, and is a major cause of morbidity, impaired mobility, pathologic fractures, spinal cord compression and bone marrow aplasia. The cumulative incidence of bone metastasis across all cancer histologies is approximately 12% at 10 years, with a relative incidence ranging from 20-40% for renal cell carcinoma and melanoma to 65-75% in breast cancer and prostate cancer patients.
Treatment paradigms have shifted over the last 5 years with modern targeted agents and immunotherapy allowing many patients to live longer with metastatic disease. Importantly, improving the durability of pain control is important to preserving quality of life in these patients. The standard of care for painful bone metastasis is single or multi fraction conventional palliative radiation (CRT) ranging from 8 Gy x1 fraction to 30 Gy in 10 fractions. Practice patterns vary on the length of treatment for patients and shorter treatments are less burdensome on the patient’s quality of life. Compared to conventional palliative radiation stereotactic body radiation therapy delivers a higher ablative radiation dose. It is hypothesized this will translate into improved local control and durable pain control.
A phase II non-inferiority trial comparing single fraction Stereotactic Body Radiotherapy (SBRT) (12 to 16 Gy x1) to CRT (30 Gy in 10 fractions) demonstrated more durable pain response at 9 months 77% (SBRT) vs 46% (CRT) (p=0.04). Overall survival did not differ. Local progression-free survival was improved with the SBRT 100% vs 90.5% in the CRT at 1 year and 2 years 100% SBRT vs 75.6% in CRT group (p=0.01). No differences were noted in acute and late toxicities. In addition, the SAFFRON meta-analysis of SBRT for spine metastasis demonstrated a significant local control benefit compared to conventional RT.
Therefore, novel applications of SBRT for bone metastasis are needed to continue to improve long-term outcomes for metastatic cancer patients. However, the problem is that the use of SBRT for bone metastasis (spine and non-spine) is not currently considered the standard of care and is used only for well-selected patients.
The aim is to collect original manuscripts, which address novel uses of SBRT for bone metastasis to continue to increase the amount of evidence supporting the use of SBRT. We will also collect review articles from content experts to address the current state of the literature and future directions. The below will be considered:
- Stereotactic body radiation (SBRT) for painful bone metastasis - Long term outcomes from SBRT bone metastasis studies, QOL, pain response and narcotic use following SBRT
- Novel applications of SBRT for spine metastasis - High number of boney sites or vertebral body lengths, circumferential tumor involvement (around an OAR example cord or nerve root), combination of surgery and SBRT, patterns of failure in the sacrum/iliac bones, improve target definition
- SBRT for oligometastasis
- SBRT for oligoprogression
- Combination of SBRT with Laser interstitial therapy (LITT)
- Novel imaging for SBRT target definition
- Serum biomarkers of tumor response
- Imaging biomarkers of tumor progression vs radiation treatment effect - MRI imaging (perfusion imaging), PET imaging
- The use of SBRT for non-spine bone metastasis
- The use of SBRT for spine metastasis
- The combination of LITT and SBRT for spine metastasis
- The use of imaging for treatment and monitoring response for bone metastasis