ESTRO 36 Abstract Book

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S741 ESTRO 36 2017
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EP-1402 Impact of SBRT on pain and local control for
bone metastases: a systematic review and meta-analysis
J.M. Van der Velden1, A.S. Gerlich1, E. Wong2, E. Chow2,
M. Intven1, N. Kasperts1, W.S.C. Eppinga1, E. Seravalli 1,
M. Van Vulpen1, H.M. Verkooijen1
1 UMC Utrecht, Department of Radiation Oncology,
Utrecht, The Netherlands
2 Sunnybrook Odette Cancer Center, Radiation Oncology,
Toronto, Canada
Purpose or Objective
Pain due to bone metastases is the most common cancer-
related pain syndrome. Besides analgesics, conventional
radiotherapy has been the cornerstone in the management
of bone metastases. However, control of pain after
conventional radiotherapy is modest, approximately 60%.
Advances in radiotherapy technique enable the delivery of
potentially ablative radiation doses, while respecting
healthy tissue constraints under the heading of
stereotactic body radiotherapy (SBRT). We conducted a
systematic review and meta-analysis to quantify pain
response and local control after SBRT for bone metastases.
Material and Methods
Following the Preferred Reporting Items for Systematic
reviews and Meta-Analyses (PRISMA) guideline, Embase,
PubMed and Cochrane Libraries were searched with the
(synonym) terms ‘bone metastases’ and ‘stereotactic body
radiotherapy’. Studies delivering SBRT in 1 – 6 fractions to
patients with or without previous radiotherapy or surgery
were included. Information from studies reported in more
than one publication was collated, and the most complete
or recent article was cited. Study variables, including pain
response and local control rates, were extracted from the
selected articles. Pain response was defined as a complete
or partial (i.e., at least 2 points decrease in pain score)
response. To qualify for inclusion in the meta-analysis,
outcomes had to be reported on an individual patient or
lesion level, follow up had to be recorded at least 45% of
the study population, and the size of the study population
had to be 10 or more. Pooled estimates using random-
effects models were calculated for pain response and local
control rates.
Results
After screening of 2619 unique articles, 54 articles (3359
patients) were included in the systematic review. Twenty-
six articles (1627 patients/lesions) were included in the
meta-analysis for pain response, and 36 articles (2875
lesions) in the meta-analysis for local control. After SBRT,
pain response rate ranged from 62% to 98% (see forest
plot), and local control rate ranged between 25% and 97%
(see forest plot). Excluding the study with the lowest local
control rate, which included patients with spinal lesions
from hepatocellular carcinoma, the local control rates
varied between 74% and 97%. Pooled pain response rate
was 80% (95% confidence interval [CI] 72% – 87%) with high
heterogeneity (I2 = 77%). Pooled local control rate was 87%
(95% CI 84% – 90%) with high heterogeneity (I2 = 76%).
Conclusion
SBRT for bone metastases results in high pain control and
high local control rates. This observation needs to be
further confirmed within large randomized controlled
trials.
EP-1403 A comparison between 3D and volumetric
technique in lumbar vertebral palliative irradiation
N. Ricottone 1, N. Cavalli2, E. Bonanno2, C. Marino2, G.
Pisasale1, A. D'Agostino1, A. Girlando1
1HUMANITAS CCO, Radiation Oncology, Catania, Italy
2HUMANITAS CCO, Medical Physics, Catania, Italy
Purpose or Objective
Lumbar rachis radiation treatment requires to take into
account dose to kidneys. Aim of this paper is to evaluate
if volumetric techniques can give an advantage when
irradiating young patients, patient with a long life
expectancy or patients with renal dysfunction. The clinical
advantage is to preserve renal function and to not
interfere with previous or further medical treatments that
make use of renal toxic drugs, as for instance: cisplatin,
carboplatin, ifosfamide.
Material and Methods
A comparison between four plans were performed: a two
fields three dimensional (3D) anterior-posterior plan (3D-
2F); a three fields (0°-150°-210°) 3D plan (3D-3F); a VMAT
plan and a second VMAT plan spine sparing (VMAT-SS).
Dose prescription was 30 Gy in 10 fractions. All plans were
calculated with Eclipse 13.6 using AAA algorithm. 3D plans
were calculated using MLC shielding and different
weighted fields; regarding VMAT plans dose constraints
according to QUANTEC were used.
Results
Even if dose delivered to kidneys do not exceed QUANTEC
dose constraints, VMAT plans achieve better results in
term of dose reduction to OARs particularly for kidneys (as