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Published on: June 7, 2015
Preoperative Stereotactic Body Radiotherapy for Metastatic Bone Disease With Impending Fracture: A Nonrandomized
Max Vaynrub1, Meredith K Bartelstein1, Victoria Y Yu2
11Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, NY.
Summary
Preoperative stereotactic body radiation therapy (SBRT) for bone metastases shows promise, with low wound complication rates and effective tumor control. Further research is needed to confirm its benefits for surgical outcomes.
Area of Science:
- Oncology
- Radiation Oncology
- Surgical Oncology
Background:
- Standard care for impending pathologic fractures from bone metastases involves surgery and postoperative radiotherapy (RT).
- Stereotactic body RT (SBRT) offers superior tumor control but is often limited postoperatively due to volume constraints.
- Preoperative SBRT presents a potential solution by delivering ablative doses before surgery, but its safety requires evaluation.
Purpose of the Study:
- To assess the safety and efficacy of preoperative SBRT followed by surgical stabilization for impending pathologic fractures due to bone metastases.
- To evaluate the rate of wound complications within 6 weeks post-surgery.
- To determine rates of tumor recurrence and severe toxicities within 1 year.
Main Methods:
- A phase I, nonrandomized clinical trial was conducted with 38 eligible patients.
- Patients received preoperative SBRT (27-30 Gy in 3 fractions or 18-24 Gy in 1 fraction) followed by surgical stabilization within 1 week.
- Primary endpoint: wound complication rate; Secondary endpoints: tumor recurrence and grade ≥3 toxicities.
Main Results:
- 31 patients were evaluated at 6 weeks postoperatively.
- A low rate of wound complications (6.5%) was observed at 6 weeks.
- At 1 year, tumor recurrence was observed in 6.3% of patients, with low rates of severe toxicity.
Conclusions:
- Preoperative SBRT demonstrates a low risk of wound complications when combined with surgical stabilization for bone metastases.
- The treatment provides durable local tumor control.
- A randomized controlled trial is recommended to further investigate efficacy, surgical facilitation, and functional outcomes.
