Spinal stereotactic radiotherapy for painful spinal metastasis
Mené au Canada et en Australie sur 229 patients adultes présentant des métastases vertébrales douloureuses (durée médiane de suivi : 6,7 mois), cet essai randomisé de phase II/III évalue l'efficacité, du point de vue de la réduction de la douleur, et la toxicité d'une radiothérapie corporelle stéréotaxique par rapport à une radiothérapie externe conventionnelle
Conventional external beam radiotherapy is the standard of care for patients with cancer who have localised metastatic bone pain. Pain response is reported as a combination of complete (defined as a pain score of 0 on an 11-point scale of 0–10) and partial (defined as a reduction of
≥
2 points, without an increase in analgesic consumption) responses, in accordance with the International Consensus Pain Response Endpoints to promote consistent reporting in clinical trials. Pooled data from almost 30 randomised trials show that 65% of patients treated with conventional external beam radiotherapy had an overall response for pain (ie, a partial or complete response) and 25% had a complete response for pain. This review 2 also showed that dose escalation with multiple fractions of conventional external beam radiotherapy did not increase the complete response rate for pain. Therefore, a dose of 8 Gy in a single fraction is considered the gold standard for treating painful bone metastases. With the aim of further improving response rates for pain, stereotactic body radiotherapy, which enables the delivery of high doses of radiation with high precision, has been studied over the past 15 years in patients with bone metastases.
The Lancet Oncology 2021