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Annals of Palliative Medicine
Article . 2025 . Peer-reviewed
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Article . 2025
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Impact of recent clinical trials on meta-analysis of stereotactic body radiation therapy for spine metastases and urgent call for consistent study endpoints

Authors: Wong, Henry C.Y.; Lee, Shing Fung; Ryu, Samuel; Chan, Adrian Wai; Caini, Saverio; Johnstone, Peter; van der Linden, Yvette; +15 Authors

Impact of recent clinical trials on meta-analysis of stereotactic body radiation therapy for spine metastases and urgent call for consistent study endpoints

Abstract

Pain from spinal metastases can result in significant impact to patients' quality of life. Conventional external beam radiation therapy (cEBRT) has long been shown to be effective in the pain control of patients with spinal metastases. With the advancement in radiation therapy, stereotactic body radiation therapy (SBRT) has been increasingly adopted for the treatment of spinal metastases. Multiple randomised controlled trials (RCT) have been performed to evaluate whether SBRT provides better pain relief compared to cEBRT. Previous meta-analyses showed that SBRT have significantly better complete pain response at 3 months compared to cEBRT. This report updates meta-analyses by incorporating the complete pain response data obtained from personal communication with the NRG Oncology Radiation Therapy Oncology Group (RTOG) 0631 principal investigator and the recently published RCT by Guckenberger et al. The results demonstrate that the results for complete pain response at 3 months have now changed and no longer favour SBRT. It is postulated that inconsistent definitions and reporting of study endpoints, specifically regarding vertebral compression fractures induced by radiation therapy, could be possible reasons for the difference in meta-analyses results. A consensus for standardizing study endpoints for future clinical trials in SBRT for painful bone metastases is needed to allow for better interpretation of study results.

Keywords

Spinal Neoplasms, Spine metastases, Cancer Pain/radiotherapy, Spinal Neoplasms/secondary, 3202 Clinical sciences, 4203 Health services and systems, Cancer Pain, stereotactic body radiation therapy (SBRT), Radiosurgery, Meta-Analysis as Topic, Journal Article, Humans, palliative radiotherapy, Radiosurgery/methods, Meta-Analysis, Randomized Controlled Trials as Topic

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
Average
Average
Green
gold
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Cancer Research