Christ Sebastian M, Kretschmer Eva-Maria, Mayinger Michael, Day Madalyne, Weitkamp Nienke, Moreira Amanda Kristina, Ehrbar Stefanie, Reiner Cäcilia S, Bogowicz Marta, Wilke Lotte, Tanadini-Lang Stephanie, Andratschke Nicolaus, Garcia Schüler Helena I, Guckenberger Matthias
Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Clin Transl Radiat Oncol. 2025 Apr 27;53:100966. doi: 10.1016/j.ctro.2025.100966. eCollection 2025 Jul.
There is evidence for efficacy of high-dose single-fraction stereotactic body radiotherapy (SF-SBRT) for painful non-spine bone metastases (NSBMs). This study ("BONE SHOT") assessed feasibility of same-day magnetic resonance-guided (MRg) planning and SF-SBRT delivery, recorded toxicity and assessed efficacy for treating metastatic patients with NSBMs.
Patients with painful (≥3/10 points on a 0-10 numeric rating scale (NRS) for pain) and radiologically confirmed NSBMs from solid organ malignancies were eligible for this prospectively acquired, single-center study. Patients received MRg-SF-SBRT via MR-Linac (ViewRay®) with same-day consultation, consent, planning and treatment. Drop-out rate, procedure times, acute toxicity and pain response were recorded.
Between June 2019 and June 2020, 13 patients with 15 NSBMs were treated per protocol. Mean patient age was 64 (range, 30-87) years; most common primary cancer was gastrointestinal malignancies (38.5 %); most commonly treated site was pelvis (53.3 %). All workflows were completed as planned. Median on-table time for contouring, planning and delivery was 65 (range, 57-112) minutes. Treatments were well tolerated; one patient developed "pain flair"; no grade ≥ 3 toxicities were registered. At one week following SBRT, overall and complete pain response rates were 73.3 % and 20.0 %, respectively, which evolved to 66.7 % and 53.3 % at four weeks after SBRT; median pre-treatment pain score was 6 points, which was reduced by a median of 5 points (P = 0.0028) at four weeks.
The same-day MRg-SF-SBRT workflow for NSBMs was feasible, safe, and preliminary results indicate promising efficacy, warranting future trials investigating this intervention.
有证据表明高剂量单次分割立体定向体部放疗（SF-SBRT）对疼痛性非脊柱骨转移瘤（NSBMs）有效。本研究（“骨射”）评估了同日磁共振引导（MRg）计划和SF-SBRT治疗的可行性，记录了毒性反应，并评估了治疗NSBMs转移患者的疗效。
本前瞻性单中心研究纳入了因实体器官恶性肿瘤导致疼痛（在0-10数字评分量表（NRS）上疼痛评分≥3分）且经放射学证实为NSBMs的患者。患者通过MR直线加速器（ViewRay®）接受MRg-SF-SBRT治疗，包括同日会诊、签署知情同意书、计划制定和治疗。记录退出率、操作时间、急性毒性反应和疼痛反应。
在2019年6月至2020年6月期间，按照方案共治疗了13例患者的15处NSBMs。患者平均年龄为64岁（范围30-87岁）；最常见的原发癌是胃肠道恶性肿瘤（38.5%）；最常治疗的部位是骨盆（53.3%）。所有工作流程均按计划完成。轮廓勾画、计划制定和治疗的中位手术台上时间为65分钟（范围57-112分钟）。治疗耐受性良好；1例患者出现“疼痛加剧”；未记录到≥3级毒性反应。SBRT治疗后1周，总体疼痛缓解率和完全疼痛缓解率分别为73.3%和20.0%，在SBRT治疗后4周分别升至66.7%和53.3%；治疗前中位疼痛评分为6分，在4周时中位降低了5分（P = 0.0028）。
NSBMs的同日MRg-SF-SBRT工作流程是可行、安全的，初步结果显示疗效良好，值得未来开展试验研究这种干预措施。
