Palliative radiation targeted directly to the tumor with stereotactic body radiation therapy (SBRT) eliminated metastatic pain in 33% of patients for six months compared to 16% with standard radiation therapy. Researchers reported the study findings at the American Society for Radiation Oncology annual meeting.
The researchers randomized 229 patients with painful spine metastases one to one to receive either standard radiation (20 Gy in five fractions) or high-dose, targeted SBRT (24 Gy in two fractions). At three months, 14% of patients in the standard arm versus 36% in the SBRT arm reported complete resolution of pain. At six months, the responses were 16% and 33% for standard therapy and SBRT, respectively. A total of 17% of patients receiving standard therapy and 11% of those in the SBRT arm had post-radiation vertebral compression fractures, and two of those patients progressed to malignant epidural spinal cord compression in the standard therapy arm only.
“This is one way to help patients with metastatic disease in a tangible way: by reducing pain,” the researchers said. “This isn’t for the patient who has pain everywhere in the spine, which is unfortunately the majority of patients. But if you have a defined region of metastatic disease in the spine, and you can pinpoint the pain to that region, that’s going to be who benefits.”