Prognostic Models for Patient Selection in Palliative Bone Radiotherapy: A Systematic Review

Area of Science:

• Oncology
• Radiotherapy
• Biostatistics

Background:

• Palliative radiotherapy effectively manages symptomatic bone metastases.
• Accurate prognosis is vital for selecting patients likely to benefit, especially those with a limited prognosis (under 3 months).
• Existing prognostic tools require evaluation for their utility in this specific patient group.

Purpose of the Study:

• To systematically review prognostic models used for patient selection in palliative radiotherapy for bone metastases.
• To assess the performance and risk of bias of identified prognostic models.

Main Methods:

• A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
• Searches were conducted across PubMed, Scopus, and Web of Science databases.
• Risk of bias was evaluated using the Prediction model Risk Of Bias ASsessment Tool (PROBAST).

Main Results:

• Nineteen studies were included, characterized by heterogeneity in study design (mostly retrospective) and patient populations.
• A wide array of prognostic approaches were identified, including established scores, novel tools, and individual factors.
• Performance status emerged as the most significant prognostic variable; however, most models exhibited high or unclear risk of bias.

Conclusions:

• Prognostic models show potential for optimizing patient selection for palliative radiotherapy for bone metastases.
• The heterogeneity of models and patient populations underscores the need for robust external validation.
• The clinical utility of these models depends on local context, clinician expertise, and individual patient characteristics.