A phase III randomized-controlled, single-blind trial to improve quality of life with stereotactic body radiotherapy for patients with painful bone metastases (ROBOMET)

Carole Mercier,Yolande Lievens,Ines Joye,Piet Ost,Piet Dirix,Dirk Verellen,Peter Vermeulen,Charlotte Billiet

doi:10.1186/s12885-019-6097-z

Abstract

BackgroundBone metastases represent an important source of morbidity in cancer patients, mostly due to severe pain. Radiotherapy is an established symptomatic treatment for painful bone metastases, however, when conventional techniques are used, the effectiveness is moderate. Stereotactic body radiotherapy (SBRT), delivering very high doses in a limited number of fractions in a highly conformal manner, could potentially be more effective and less toxic.MethodsThis is a phase III, randomized-controlled, single-blind, multicenter study evaluating the response rate of antalgic radiotherapy for painful bone metastases and the acute toxicity associated with this treatment. A total of 126 patients will be randomly assigned to receive either the standard schedule of a single fraction of 8.0 Gy delivered through three-dimensional conformal radiotherapy or a single fraction of 20.0 Gy delivered through SBRT. Primary endpoint is pain response at the treated site at 1 month after radiotherapy. Secondary endpoints are pain flare at 24–48-72 h after radiotherapy, duration of pain response, re-irradiation need, acute toxicity, late toxicity, quality of life and subsequent serious skeletal events. In a supplementary analysis, patient-compliance for a paper-and-pencil questionnaire will be compared with an electronic mode.DiscussionIf a dose-escalated approach within the context of single fraction stereotactic body radiotherapy could improve the pain response to radiotherapy and minimize acute toxicity, this would have an immediate impact on the quality of life for a large number of patients with advanced cancer. Potential disadvantages of this technique include increased pain flare or a higher incidence of radiation-induced fractures.Trial registrationThe Ethics committee of the GZA Hospitals (B099201732915) approved this study on September 4th 2018. Trial registered on Clinicaltrials.gov (NCT03831243) on February 5th 2019.

Highlights

Bone metastases represent an important source of morbidity in cancer patients, mostly due to severe pain
It is to be assumed that with these truly “ablative” doses, a higher response rate can be achieved and longer duration of pain control and less re-irradiation need. Perhaps this increased efficacy will compensate the higher treatment cost of Stereotactic body radiotherapy (SBRT), through less re-treatment and less symptomatic skeletal events (SSEs, consisting of symptomatic pathologic fractures, radiation or surgery to bone, and spinal cord compression). Study design This is a phase III, randomized-controlled, single-blind, multicenter study comparing the standard schedule for antalgic radiotherapy of a single fraction of 8.0 Gy delivered through 3D-conformal radiotherapy (3D-CRT) to a single fraction of 20.0 Gy delivered through SBRT (Fig. 1)
In this report, we present the rationale and design of the ROBOMET trial, a randomized study in radiotherapy for painful bone metastases investigating whether SBRT can increase the pain response while at the same time limit the side-effects

Summary

Methods

This is a phase III, randomized-controlled, single-blind, multicenter study evaluating the response rate of antalgic radiotherapy for painful bone metastases and the acute toxicity associated with this treatment. A total of 126 patients will be randomly assigned to receive either the standard schedule of a single fraction of 8.0 Gy delivered through three-dimensional conformal radiotherapy or a single fraction of 20.0 Gy delivered through SBRT. Primary endpoint is pain response at the treated site at 1 month after radiotherapy. Secondary endpoints are pain flare at 24–48-72 h after radiotherapy, duration of pain response, re-irradiation need, acute toxicity, late toxicity, quality of life and subsequent serious skeletal events. Patient-compliance for a paper-and-pencil questionnaire will be compared with an electronic mode

Discussion

Background

Methods/design

Findings