Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Radiation Oncology, Iridium Netwerk, Antwerpen, Belgium.
JAMA Netw Open. 2024 Feb 5;7(2):e2355409. doi: 10.1001/jamanetworkopen.2023.55409.
Conventional external beam radiotherapy (cEBRT) and stereotactic body radiotherapy (SBRT) are commonly used treatment options for relieving metastatic bone pain. The effectiveness of SBRT compared with cEBRT in pain relief has been a subject of debate, and conflicting results have been reported.
To compare the effectiveness associated with SBRT vs cEBRT for relieving metastatic bone pain.
A structured search was performed in the PubMed, Embase, and Cochrane databases on June 5, 2023. Additionally, results were added from a new randomized clinical trial (RCT) and additional unpublished data from an already published RCT.
Comparative studies reporting pain response after SBRT vs cEBRT in patients with painful bone metastases.
Two independent reviewers extracted data from eligible studies. Data were extracted for the intention-to-treat (ITT) and per-protocol (PP) populations. The study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.
Overall and complete pain response at 1, 3, and 6 months after radiotherapy, according to the study's definition. Relative risk ratios (RRs) with 95% CIs were calculated for each study. A random-effects model using a restricted maximum likelihood estimator was applied for meta-analysis.
There were 18 studies with 1685 patients included in the systematic review and 8 RCTs with 1090 patients were included in the meta-analysis. In 7 RCTs, overall pain response was defined according to the International Consensus on Palliative Radiotherapy Endpoints in clinical trials (ICPRE). The complete pain response was reported in 6 RCTs, all defined according to the ICPRE. The ITT meta-analyses showed that the overall pain response rates did not differ between cEBRT and SBRT at 1 (RR, 1.14; 95% CI, 0.99-1.30), 3 (RR, 1.19; 95% CI, 0.96-1.47), or 6 (RR, 1.22; 95% CI, 0.96-1.54) months. However, SBRT was associated with a higher complete pain response at 1 (RR, 1.43; 95% CI, 1.02-2.01), 3 (RR, 1.80; 95% CI, 1.16-2.78), and 6 (RR, 2.47; 95% CI, 1.24-4.91) months after radiotherapy. The PP meta-analyses showed comparable results.
In this systematic review and meta-analysis, patients with painful bone metastases experienced similar overall pain response after SBRT compared with cEBRT. More patients had complete pain alleviation after SBRT, suggesting that selected subgroups will benefit from SBRT.
传统的外照射放射治疗（cEBRT）和立体定向体放射治疗（SBRT）是缓解转移性骨痛的常用治疗选择。SBRT 在缓解疼痛方面与 cEBRT 的有效性一直是一个争论的话题，并且已经报道了相互矛盾的结果。
比较 SBRT 与 cEBRT 缓解转移性骨痛的效果。
于 2023 年 6 月 5 日在 PubMed、Embase 和 Cochrane 数据库中进行了结构化检索。此外，还从一项新的随机临床试验（RCT）和已发表 RCT 的额外未发表数据中添加了结果。
比较报告 SBRT 与 cEBRT 治疗骨转移疼痛患者疼痛缓解的研究。
两名独立的审查员从合格的研究中提取数据。为意向治疗（ITT）和符合方案（PP）人群提取了数据。该研究按照系统评价和荟萃分析的首选报告项目（PRISMA）报告指南进行报告。
根据研究定义，放射治疗后 1、3 和 6 个月的总体和完全疼痛缓解。对于每个研究，计算了 95%置信区间（CI）的相对风险比（RR）。应用具有受限最大似然估计的随机效应模型进行荟萃分析。
系统评价纳入了 18 项研究共 1685 例患者，荟萃分析纳入了 8 项 RCT 共 1090 例患者。在 7 项 RCT 中，总体疼痛缓解根据国际姑息性放射治疗终点共识（ICPRE）进行定义。6 项 RCT 报告了完全疼痛缓解，均根据 ICPRE 进行定义。ITT 荟萃分析显示，cEBRT 和 SBRT 在 1 个月（RR，1.14；95%CI，0.99-1.30）、3 个月（RR，1.19；95%CI，0.96-1.47）和 6 个月（RR，1.22；95%CI，0.96-1.54）时的总体疼痛缓解率没有差异。然而，SBRT 在 1 个月（RR，1.43；95%CI，1.02-2.01）、3 个月（RR，1.80；95%CI，1.16-2.78）和 6 个月（RR，2.47；95%CI，1.24-4.91）时与更高的完全疼痛缓解相关。PP 荟萃分析显示出相似的结果。
在这项系统评价和荟萃分析中，患有骨转移疼痛的患者在 SBRT 后经历了类似的总体疼痛缓解。更多的患者在 SBRT 后疼痛完全缓解，这表明某些亚组将受益于 SBRT。
