EP-1402: Impact of SBRT on pain and local control for bone metastases: a systematic review and meta-analysis

Abstract Background Stereotactic radiotherapy (SBRT) might improve pain and local control in patients with bone metastases compared to conventional radiotherapy, although an overall estimate of these outcomes is currently unknown. Methods A systematic review was carried out following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pubmed, Embase, and Cochrane databases were systematically searched to identify studies reporting pain response and local control among patients with bone metastases from solid-organ tumors who underwent SBRT in 1–6 fractions. All studies prior to April 15, 2017, were included. Study quality was assessed by predefined criteria, and pain response and local control rates were extracted. Results A total of 2619 studies were screened; 57 were included (reporting outcomes for 3995 patients) of which 38 reported pain response and 45 local control rates. Local control rates were high with pain response rates above those previously reported for conventional radiotherapy. Marked heterogeneity in study populations and delivered treatments were identified such that quantitative synthesis was not appropriate. Reported toxicity was limited. Of the pain response studies, 73.7% used a retrospective cohort design and only 10.5% used the international consensus endpoint definitions of pain response. The median survival within the included studies ranged from 8 to 30.4 months, suggesting a high risk of selection bias in the included observational studies. Conclusions This review demonstrates the potential benefit of SBRT over conventional palliative radiotherapy in improving pain due to bone metastases. Given the methodological limitations of the published literature, however, large randomized trials are now urgently required to better quantify this benefit.

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Systematic review and meta-analysis on the proportion of patients with breast cancer who develop bone metastases

Critical Reviews in Oncology/Hematology ◽

10.1016/j.critrevonc.2017.04.008 ◽

2017 ◽

Vol 115 ◽

pp. 67-80 ◽

Cited By ~ 24

Author(s):

Jean-Jacques Body ◽

Geoffrey Quinn ◽

Susan Talbot ◽

Emma Booth ◽

Gaston Demonty ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Bone Metastases ◽

Meta Analysis

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De-escalation of bone-modifying agents in patients with bone metastases from breast cancer: a systematic review and meta-analysis

Breast Cancer Research and Treatment ◽

10.1007/s10549-019-05265-1 ◽

2019 ◽

Vol 176 (3) ◽

pp. 507-517 ◽

Cited By ~ 2

Author(s):

Arif Ali Awan ◽

Brian Hutton ◽

John Hilton ◽

Sasha Mazzarello ◽

Catherine Van Poznak ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Bone Metastases ◽

Meta Analysis

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Should de-escalation of bone-targeting agents be standard of care for patients with bone metastases from breast cancer? A systematic review and meta-analysis

Annals of Oncology ◽

10.1093/annonc/mdv284 ◽

2015 ◽

Vol 26 (11) ◽

pp. 2205-2213 ◽

Cited By ~ 26

Author(s):

M.F.K. Ibrahim ◽

S. Mazzarello ◽

R. Shorr ◽

L. Vandermeer ◽

C. Jacobs ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Bone Metastases ◽

Meta Analysis ◽

Standard Of Care ◽

Bone Targeting

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Denosumab for treatment of bone metastases secondary to solid tumours: Systematic review and network meta-analysis

European Journal of Cancer ◽

10.1016/j.ejca.2012.07.016 ◽

2013 ◽

Vol 49 (2) ◽

pp. 416-430 ◽

Cited By ~ 37

Author(s):

John A. Ford ◽

Rob Jones ◽

Andrew Elders ◽

Clive Mulatero ◽

Pamela Royle ◽

...

Keyword(s):

Systematic Review ◽

Bone Metastases ◽

Meta Analysis ◽

Solid Tumours

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Is De-escalated Bisphosphonates Therapy a Suitable Alternative to Standard Dosing in Malignant Tumor Patients With Bone Metastases: A Systematic Review and Meta-Analysis

Frontiers in Oncology ◽

10.3389/fonc.2019.00774 ◽

2019 ◽

Vol 9 ◽

Author(s):

Qiuhua Luo ◽

Peng Men ◽

Zhiyong Liu ◽

Suodi Zhai ◽

Mingyan Jiang

Keyword(s):

Systematic Review ◽

Bone Metastases ◽

Malignant Tumor ◽

Meta Analysis ◽

Tumor Patients ◽

Suitable Alternative

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Comparative efficacy and safety of bone-modifying agents for the treatment of bone metastases in patients with advanced renal cell carcinoma: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e16067 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e16067-e16067

Author(s):

Kenji Omae ◽

Yasushi Tsujimoto ◽

Michitaka Honda ◽

Tsunenori Kondo ◽

Yasunobu Hashimoto ◽

...

Keyword(s):

Systematic Review ◽

Renal Cell Carcinoma ◽

Zoledronic Acid ◽

Bone Metastases ◽

Cell Carcinoma ◽

Renal Cell ◽

Meta Analysis ◽

Controlled Trials ◽

Cochrane Central Register ◽

Efficacy And Safety

e16067 Background: Bone-modifying agents (BMA) have been well-demonstrated to be effective for preventing and inhibiting skeletal-related events (SRE) in patients with bone metastases of breast or prostate cancer. However, the role of BMA treatment has not yet been clearly defined in patients with bone metastases of renal cell carcinoma (RCC). We, therefore, conducted a systematic review and meta-analysis to evaluate the efficacy and safety of BMA in patients with bone metastases of RCC. Methods: Literature search was conducted on MEDLINE, the Cochrane Central Register of Controlled Trials, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov to identify randomized controlled trials of BMA for the treatment of bone metastases in RCC patients. The primary outcomes were SRE and serious adverse events (AEs). Hazard ratios (HRs) were calculated with a random effects model. The Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of the evidence. This review was prospectively registered on PROSPERO (No. CRD42016032742). Results: Three studies (259 patients) were identified for the systematic review. Two studies that compared zoledronic acid with placebo or non-zoledronic acid showed that zoledronic acid reduced the SRE risk by 68% (HR 0.32; 95% confidence interval (CI) 0.19–0.55; P < 0.0001). The quality of evidence was moderate. No serious osteonecrosis was reported in both studies. The incidence of serious AEs was identical (80%) on both treatment arms in one study and not reported in the other study. In the remaining study, which compared denosumab with zoledronic acid, analyses of the individual patient data shared through Amgen showed a favorable trend for denosumab in terms of SRE (HR 0.71; 95% CI 0.43–1.17) and serious AEs (risk ratio 0.86; 95% CI 0.68–1.08), but this trend did not reach statistical significance. Conclusions: The moderate-quality evidence indicates that zoledronic acid significantly reduces the risk of SRE among patients with bone metastases of RCC.

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