Stereotactic body radiotherapy for non-spine bone metastases: A meta-analysis and international stereotactic radiosurgery society (ISRS) clinical practice guidelines

Timothy K Nguyen; Alexander V Louie; Rupesh Kotecha; Anshul Saxena; Yanjia Zhang; Matthias Guckenberger; Mi-Sook Kim; Marta Scorsetti; Ben J Slotman; Simon S Lo; Arjun Sahgal; Alison C Tree

doi:10.1016/j.radonc.2025.110717

Stereotactic body radiotherapy for non-spine bone metastases: A meta-analysis and international stereotactic radiosurgery society (ISRS) clinical practice guidelines

Radiother Oncol. 2025 Jan 23:205:110717. doi: 10.1016/j.radonc.2025.110717. Online ahead of print.

Authors

Affiliations

¹ Department of Radiation Oncology, London Health Sciences Centre, Western University, Ontario, Canada. Electronic address: timothy.nguyen@lhsc.on.ca.
² Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
³ Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
⁴ TD - Artificial Intelligence and Machine Learning, Baptist Health South Florida, Miami, FL, USA.
⁵ Department of Radiation Oncology, University of Zurich, Zurich, Switzerland.
⁶ Department of Radiation Oncology, Korea Institute Radiological and Medical Sciences, Seoul, Korea.
⁷ Department of Biomedical Sciences, Humanitas University, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy.
⁸ Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life / Cancer Biology and Immunology, Amsterdam, the Netherlands.
⁹ Department of Radiation Oncology, University of Washington School of Medicine and Fred Hutch Cancer Center, Seattle, WA, USA.
¹⁰ The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, Sutton, UK.

PMID: 39862925
DOI: 10.1016/j.radonc.2025.110717

Abstract

Background: While SBRT to NSBM has become common, particularly in the oligometastatic population, the approach to treating non-spine bone metastases (NSBM) with stereotactic body radiotherapy (SBRT) varies widely across institutions and clinical trial protocols. We present a comprehensive systematic review of the literatures to inform practice recommendations on behalf of the International Stereotactic Radiosurgery Society (ISRS).

Methods: A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies with at least 10 patients receiving SBRT for NSBM were identified and meta-analyses were completed to estimate pooled local control and overall survival rates. Published guidelines on NSBM SBRT were reviewed and consolidated.

Results: There were 25 studies included for qualitative analysis and 18 studies for quantitative analysis consisting of 13 retrospective studies, 2 non-randomized prospective studies, 1 randomized phase 2/3 trial, and a subgroup analysis of a phase I trial. The pooled local control rates at 1 and 2 years were 95 % (95 % CI: 89 %-98 %) and 94 % (95 % CI: 86 %-98 %), respectively. Pooled overall survival rates at 1 year and 2 years were 84 % (95 % CI: 73 %-91 %) and 81 % (95 % CI: 45 %-95 %), respectively. Consensus was reached on recommendations to inform treatment simulation, target delineation, dose fractionation, and anatomic site-specific recommendations.

Conclusion: We present ISRS-endorsed consensus recommendations to inform best practice of SBRT to NSBM, which we found to be efficacious and associated with low rates of adverse events.

Publication types

Review