Stereotactic body radiotherapy for painful spinal metastases.

Abstract

We would like to congratulate Arjun Sahgal and colleagues 1 Sahgal A Myrehaug SD Siva S et al. Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trial. Lancet Oncol. 2021; 22: 1023-1033 Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar on the excellent trial they have presented. The relevant results and innovative approach make their work a cornerstone in current radiotherapy. However, we would like to direct the authors’ and the readers’ attention to a detail that might have a practically relevant role. Although we believe that stereotactic body radiotherapy is an important therapeutic option for patients with painful spinal metastases and that the presented schedule (24 Gy in two daily fractions) is currently the most promising, we wonder whether proposing such an approach for a real-word clinical scenario (ie, replacing conventional palliative fractionation with stereotactic body radiotherapy) is not premature. In our opinion, some issues still require investigation. What patients are most indicated to undergo stereotactic body radiotherapy? What is the optimal schedule? What are the best contouring and planning approaches to consider? We will briefly explain our concerns in these regards. Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trialStereotactic body radiotherapy at a dose of 24 Gy in two daily fractions was superior to conventional external beam radiotherapy at a dose of 20 Gy in five daily fractions in improving the complete response rate for pain. These results suggest that use of conformal, image-guided, stereotactically dose-escalated radiotherapy is appropriate in the palliative setting for symptom control for selected patients with painful spinal metastases, and an increased awareness of the need for specialised and multidisciplinary involvement in the delivery of end-of-life care is needed. Full-Text PDF