Radiotherapy for asymptomatic bone metastases prolongs survival and prevents pain

October 26, 2022

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Gillespie EF, et al. Abstract LBA 04. Presented at: Annual Meeting of the American Society of Radiation Oncology; October 23-26, 2022; San Antonio.

Disclosures:
Gillespie does not report relevant financial disclosures.


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Palliative radiation therapy for asymptomatic high-risk bone metastases significantly prolonged OS and reduced skeletal-related events compared with standard therapy, phase 2 trial results showed.

The findings of the randomized study, presented at the annual meeting of the American Society for Radiation Oncology, suggest that painful complications related to solid tumors can be prevented by treating asymptomatic bone metastases with radiation therapy, the researchers noted.

Results of patients with asymptomatic metastases

Background

Radiation therapy is the standard of care for symptomatic bone metastases and there is much evidence of its benefit for pain management in cancer patientsaccording to Dr. Erin F. Gillespie, radiation oncology assistant at Memorial Sloan Kettering Cancer Center.

Erin Gillespie

Erin F. Gillespie

“The question has often been raised as to whether to treat asymptomatic bone metastases, particularly those arising in critical locations that we know may be associated with additional complications,” he said during the presentation.

His group’s experience suggests that bone metastases can become painful and lead to subsequent hospitalizations. Additionally, Gillespie said these lesions are often present on earlier images.

“The question we asked ourselves is whether radiation given to these lesions, before they become painful, actually prevents complications … and improves the patient’s quality of life.”

Methodology

Gillespie and colleagues enrolled 78 patients with 122 bone metastases for the phase 2 study to examine the prophylactic use of palliative radiation therapy in adults with asymptomatic high-risk bone metastases versus standard-of-care therapy.

The most common primary disease types included lung cancer (27%), breast cancer (24%), and prostate cancer (22%). Eligible patients had at least five metastatic lesions, including one asymptomatic high-risk lesion.

The investigators randomly assigned patients in a 1:1 ratio to receive prophylactic radiation therapy (n = 39) or standard care without radiation therapy (n = 39).

Skeletal-related events, including fracture, cord compression, or surgical/radiation intervention, served as the primary study outcome, analyzed as time from treatment randomization to death or 1-year follow-up. The researchers sought to determine whether prophylactic treatment of asymptomatic lesions prevents these events, which can increase the risk of death and health care costs.

The median follow-up was 2.4 years.

Key results

The results showed significantly fewer skeletal-related events in the radiotherapy group compared to standard care group (1.6% vs. 29%; P < .001).

The investigators reported that there were no patients hospitalized for skeletal-related events in the radiation therapy group compared with 11% of those in the standard care group (P = .045).

The investigators also reported a significantly longer median OS in the radiation therapy group compared with the standard care group (1.7 years vs. 1 year; HR = 0.5; 95% CI, 0.28-0 .91).

Patients who received radiation reported reduced pain at 3 months compared with the standard care group (P < 0.05) and better pain-related quality of life one year after therapy, the researchers noted.

clinical implications

“This first-of-its-kind randomized trial suggests that radiation for high-risk bone metastases in pain-free patients may be a promising new treatment approach,” Gillespie told the audience. “Future research is needed to confirm the overall survival benefit, as well as optimize which patients to treat and ensure timely referral.”

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