Systematic review of the role of stereotactic radiotherapy for bone metastases

Background Stereotactic radiotherapy (SBRT) might improve pain and local control in patients with bone metastases compared to conventional radiotherapy, although an overall estimate of these outcomes is currently unknown. Methods A systematic review was carried out following PRISMA guidelines. Pubmed, Embase, and Cochrane databases were systematically searched to identify studies reporting pain response and local control among patients with bone metastases from solid-organ tumours who underwent SBRT in 1–6 fractions. All studies prior to April 15th 2017 were included. Study quality was assessed by pre-defined criteria and pain response and local control rates were extracted. Results A total of 2619 studies were screened. Fifty-seven were included (reporting outcomes for 3995 patients) of which 38 reported pain response and 45 local control rates. Local control rates were high with pain response rates above those previously reported for conventional radiotherapy. Marked heterogeneity in study populations and delivered treatments were identified such that quantitative synthesis was not appropriate. Reported toxicity was limited. 73.7% of pain response studies used a retrospective cohort design and only 10.5% used the International consensus endpoint definitions of pain response. The median survival in included studies ranged from 8 to 30.4 months suggesting a high risk of selection bias in the included observational studies. Conclusions This review demonstrates the potential benefit of SBRT over conventional palliative radiotherapy in improving pain due to bone metastases. Given the methodological limitations of the published literature, however, large randomized trials are now urgently required to better quantify this benefit.