Palliative stereotactic body radiotherapy for spinal and non-spinal bone metastases: combining tradition and...

Bone metastases can cause pain, fractures, radiculopathy, and metastatic epidural spinal cord compression, all of which substantially impair patients' quality of life. Conventional external beam radiotherapy (cEBRT) has been the standard treatment for symptomatic bone metastases. While the effectiveness and safety of cEBRT are well established, it has certain limitations, including a short duration of pain relief, limited long-term tumor control, and suboptimal efficacy against radioresistant tumors. Over the past decade, stereotactic body radiotherapy (SBRT) has been explored as a palliative treatment for bone metastases. SBRT enables the delivery of high doses of radiation to bone lesions by maximizing dose conformality. This treatment characteristic yields several clinical advantages, including considerable pain relief, durable tumor control, and efficacy against radioresistant tumors. SBRT has the potential to overcome the limitations of cEBRT and represents a promising approach that could revolutionize the treatment of bone metastases. This review addresses three clinical scenarios: painful spinal metastases, painful non-spinal bone metastases, and metastatic epidural spinal cord compression. For each scenario, we summarized the evidence for cEBRT and SBRT, highlighting the utility and potential of SBRT as an emerging treatment option.