SBRT for Uncomplicated Bone Metastases in the Spine from Lung Cancer
A literature Review
DOI:
https://doi.org/10.56226/92Keywords:
SBRT, Bone Metastases, Spine, Lung Cancer, Public HealthAbstract
Introduction: Bone metastases (BM) are common in several types of cancer, especially breast, prostate, lung, kidney and thyroid. Radiotherapy (RT) is a standard treatment for symptomatic BM, providing pain relief with minimal toxicity. Stereotactic body RT (SBRT) has emerged as an advanced technique to treat uncomplicated spinal bone metastases (UNSM) in patients with lung cancer. Methodology: A review of the scientific literature on the use of SBRT for UNSM was performed. The review included randomized controlled trials and meta-analyses, focusing on patient selection, treatment techniques and clinical outcomes. Inclusion criteria were defined, excluding imminent pathological fractures or spinal cord compression. Results: SBRT showed high rates of local control of metastases, reaching up to 90% in one year. There was significant pain relief and improvement in the quality of life of patients. Toxicities were minimal, with rare serious complications reported. Studies indicate that SBRT offers additional benefits, allowing dose escalation and minimizing toxicity compared to conventional RT. Discussion: SBRT is a promising approach to treat MONC, especially in patients with oligometastatic disease. Early detection and planned treatment of asymptomatic bone metastases can prevent serious complications, such as pathological fractures and spinal cord compression, improving pain-free survival. Current evidence supports the efficacy of SBRT, but prospective clinical trials are needed to optimize treatment protocols and patient selection. Multidisciplinary collaboration is essential for successful patient management. Conclusion: SBRT represents a significant advance in RT for uncomplicated spinal bone metastases in lung cancer, combining clinical efficacy and safety, with a positive impact on patients' quality of life. This innovative technique offers new therapeutic possibilities that should be considered in selected patients.
References
Bollen, L., Jacobs, W. C. H., Van der Linden, Y. M., Van der Hel, O., Taal, W., & Dijkstra, P. D. S. (2018). A systematic review of prognostic factors predicting survival in patients with spinal bone metastases. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 27(4), 799–805. https://doi.org/10.1007/s00586-017-5320-3
Chow, R., Hoskin, P., Schild, S. E., Raman, S., Im, J., Zhang, D., et al. (2019). Single vs multiple fraction palliative radiation therapy for bone metastases: Cumulative meta-analysis. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 141, 56–61. https://doi.org/10.1016/j.radonc.2019.06.037
Cornford, P., van den Bergh, R. C. N., Briers, E., Van den Broeck, T., Cumberbatch, M. G., De Santis, M., et al. (2021). EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer. Part II-2020 Update: Treatment of Relapsing and Metastatic Prostate Cancer. European urology, 79(2), 263–282. https://doi.org/10.1016/j.eururo.2020.09.046
Di Gioia, D., Stieber, P., Schmidt, G. P., Nagel, D., Heinemann, V., & Baur-Melnyk, A. (2015). Early detection of metastatic disease in asymptomatic breast cancer patients with whole-body imaging and defined tumour marker increase. British journal of cancer, 112(5), 809–818. https://doi.org/10.1038/bjc.2015.8
Dunne, E. M., Sahgal, A., Lo, S. S., Bergman, A., Kosztyla, R., Dea, N., et al. (2020). International consensus recommendations for target volume delineation specific to sacral metastases and spinal stereotactic body radiation therapy (SBRT). Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 145, 21–29. https://doi.org/10.1016/j.radonc.2019.11.026
Guckenberger, M., Lievens, Y., Bouma, A. B., Collette, L., Dekker, A., deSouza, N. M., et al. (2020). Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. The Lancet. Oncology, 21(1), e18–e28. https://doi.org/10.1016/S1470-2045(19)30718-1
Huisman, M., van den Bosch, M. A., Wijlemans, J. W., van Vulpen, M., van der Linden, Y. M., & Verkooijen, H. M. (2012). Effectiveness of reirradiation for painful bone metastases: a systematic review and meta-analysis. International journal of radiation oncology, biology, physics, 84(1), 8–14. https://doi.org/10.1016/j.ijrobp.2011.10.080
Jehn, C. F., Diel, I. J., Overkamp, F., Kurth, A., Schaefer, R., Miller, K., et al. (2016). Management of Metastatic Bone Disease Algorithms for Diagnostics and Treatment. Anticancer research, 36(6), 2631–2637.
Kim, T., Cha, H. J., Kim, J. W., Seong, J., & Lee, I. J. (2016). High dose and compartmental target volume may improve patient outcome after radiotherapy for pelvic bone metastases from hepatocellular carcinoma. Oncotarget, 7(33), 53921–53929. https://doi.org/10.18632/oncotarget.9767
Memorial Sloan Kettering Cancer Center. Um ensaio randomizado de radioterapia paliativa precoce versus tratamento padrão para pacientes com metástases ósseas assintomáticas ou minimamente sintomáticas de alto risco. clinicaltrials.gov; 2021.
Mottet, N., Bellmunt, J., Bolla, M., Briers, E., Cumberbatch, M. G., De Santis, M., et al. (2017). EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. European urology, 71(4), 618–629. https://doi.org/10.1016/j.eururo.2016.08.003
Mundy G. R. (2002). Metastasis to bone: causes, consequences and therapeutic opportunities. Nature reviews. Cancer, 2(8), 584–593. https://doi.org/10.1038/nrc867
Níveis de evidência do OCEBM — Centro de Medicina Baseada em Evidências (CEBM), Universidade de Oxford nd https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence
Olson, R., Schlijper, R., Chng, N., Matthews, Q., Arimare, M., Mathews, L., et al. (2019). SUPR-3D: A randomized phase iii trial comparing simple unplanned palliative radiotherapy versus 3d conformal radiotherapy for patients with bone metastases: study protocol. BMC cancer, 19(1), 1011. https://doi.org/10.1186/s12885-019-6259-z
Organização Europeia para Pesquisa e Tratamento do Câncer - EORTC. E 2 -RADIatE: EORTC-ESTRO RADioterapia InfraEstrutura para a Europa. clinicaltrials.gov; 2019.
Palma, D. A., Olson, R., Harrow, S., Gaede, S., Louie, A. V., Haasbeek, C., Mulroy, L., Lock, M., et al. (2019). Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet (London, England), 393(10185), 2051–2058. https://doi.org/10.1016/S0140-6736(18)32487-5
Palma, D. A., Olson, R., Harrow, S., Gaede, S., Louie, A. V., Haasbeek, C., et al. (2020). Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 38(25), 2830–2838. https://doi.org/10.1200/JCO.20.00818
Pielkenrood, B. J., van der Velden, J. M., van der Linden, Y. M., Bartels, M. M. T., Kasperts, N., Verhoeff, J. J. C., et al. (2021). Pain Response After Stereotactic Body Radiation Therapy Versus Conventional Radiation Therapy in Patients With Bone Metastases-A Phase 2 Randomized Controlled Trial Within a Prospective Cohort. International journal of radiation oncology, biology, physics, 110(2), 358–367. https://doi.org/10.1016/j.ijrobp.2020.11.060
Rades, D., Hueppe, M., & Schild, S. E. (2013). A score to identify patients with metastatic spinal cord compression who may be candidates for best supportive care. Cancer, 119(4), 897–903. https://doi.org/10.1002/cncr.27849
Rich, S. E., Chow, R., Raman, S., Liang Zeng, K., Lutz, S., Lam, H., et al. (2018). Update of the systematic review of palliative radiation therapy fractionation for bone metastases. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 126(3), 547–557. https://doi.org/10.1016/j.radonc.2018.01.003
Ryu, S., Deshmukh, S., Timmerman, R. D., Movsas, B., Gerszten, P., Yin, F. F., et al. (2023). Stereotactic Radiosurgery vs Conventional Radiotherapy for Localized Vertebral Metastases of the Spine: Phase 3 Results of NRG Oncology/RTOG 0631 Randomized Clinical Trial. JAMA oncology, 9(6), 800–807. https://doi.org/10.1001/jamaoncol.2023.0356
Sahgal, A., Myrehaug, S. D., Siva, S., Masucci, G. L., Maralani, P. J., Brundage, M., et al. (2021). Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trial. The Lancet. Oncology, 22(7), 1023–1033. https://doi.org/10.1016/S1470-2045(21)00196-0
Shulman, R. M., Meyer, J. E., Li, T., & Howell, K. J. (2019). External beam radiation therapy (EBRT) for asymptomatic bone metastases in patients with solid tumors reduces the risk of skeletal-related events (SREs). Annals of palliative medicine, 8(2), 159–167. https://doi.org/10.21037/apm.2018.10.04
Tiwana, M. S., Barnes, M., Yurkowski, E., Roden, K., & Olson, R. A. (2016). Incidence and treatment patterns of complicated bone metastases in a population-based radiotherapy program. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 118(3), 552–556. https://doi.org/10.1016/j.radonc.2015.10.015
Tokuhashi, Y., Matsuzaki, H., Oda, H., Oshima, M., & Ryu, J. (2005). A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine, 30(19), 2186–2191. https://doi.org/10.1097/01.brs.0000180401.06919.a5
van der Velden, J. M., van der Linden, Y. M., Versteeg, A. L., Verlaan, J. J., Sophie Gerlich, A., Pielkenrood, B. J., et al. (2018). Evaluation of effectiveness of palliative radiotherapy for bone metastases: a prospective cohort study. Journal of radiation oncology, 7(4), 325–333. https://doi.org/10.1007/s13566-018-0363-6
van de Ven, S., van den Bongard, D., Pielkenrood, B., Kasperts, N., Eppinga, W., Peters, M., et al. (2020). Patient-Reported Outcomes of Oligometastatic Patients After Conventional or Stereotactic Radiation Therapy to Bone Metastases: An Analysis of the PRESENT Cohort. International journal of radiation oncology, biology, physics, 107(1), 39–47. https://doi.org/10.1016/j.ijrobp.2019.12.041
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