Stereotactic body radiation therapy versus conventional external beam radiation therapy for painful bone metastases: A systematic review and meta-analysis of randomized trials

To compare the efficacy and safety of stereotactic body radiation therapy (SBRT) and conventional external beam radiation therapy (cEBRT) in patients with previously unirradiated painful bone metastases (BM). We searched biomedical databases for eligible randomized controlled trials (RCTs). The outcomes of interest were pain response, local progression, overall survival (OS) and adverse events. We used established tools to assess the quality of the individual trials and certainty of the pooled evidence. We performed meta-analyses using random effects models. Six RCTs were identified. SBRT improved complete pain response rates at 3 months (OR, 3.38; 95% CI, 1.88–6.07; high certainty), reduced local progression rates (OR, 0.19; 95% CI, 0.06–0.62; high certainty) and increased pain flare rates. There were no differences for other outcomes. Among patients with previously unirradiated painful BM, SBRT significantly improved complete pain response rates at 3 months, delayed local progression and increased pain flare rates. •Stereotactic body radiation therapy (SBRT) improves complete pain response and delays local progression in bone metastases.•SBRT modestly increases the risk of pain flare.•SBRT is recommended in patients with life expectancy of at least 3 months and excellent performance status.