Stereotactic body radiotherapy for spine and non-spine bone metastases in prostate carcinoma – a multicenter cohort analysis

IF 3.5 2区医学 Q2 Medicine

Journal of Bone Oncology Pub Date : 2025-09-11 DOI:10.1016/j.jbo.2025.100710

Franziska Nägler , Isabell Seiler , Sebastian Schäfer , Johannes Meents , Fabian Lohaus , Arne Grün , Olaf Wittenstein , Kenneth Klischies , Julia Remmele , Alexander Rühle , Miriam Eckl , Oliver Blanck , Judit Boda-Heggemann , Frank A. Giordano , Christos Moustakis , Nils H. Nicolay , Lena Kästner

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Abstract

Background and purpose

Metastases-directed radiotherapy plays an increasing role in oligometastatic prostate cancers (OMPC). Here, we investigated the role of stereotactic body radiotherapy (SBRT) for spine and non-spine bone metastases (BoM) from prostate cancer in a large real-world multicenter cohort.

Material and methods

This multicenter cohort analysis from five tertiary cancer centers included patient data of spine and non-spine BoM irradiated between 2010 and 2024. Overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), SBRT target volumes and doses, toxicity, and the role of additional systemic therapies were evaluated retrospectively.

Results

231 patients (341 BoM) with median follow-up time of 28.3 months were included. Most common localization were spine (39.3 %), pelvic bone (31.7 %), and ribs (17.9 %). 1- and 5-year PFS for spine BoM were 93.8 % (95 %CI:84.2–97.6 %) and 32.1 % (95 %CI:16.8–44.4 %) and for non-spine BoM 91.7 % (95 %CI:85.1–95.5 %) and 36.6 % (95 %CI:25.8–47.5 %), respectively. 1- and 5-year OS for spine BoM amounted to 94.2 % (95 %CI:85.3–97.8 %) and 69.2 % (95 %CI:50.2–82.2 %) and for non-spine 100 % and 73.3 % (95 %CI:59.1–83.3 %). Older age (p < 0.005) and additional systemic therapies (p = 0.05) were associated with worse OS, older age and larger treatment volumes with worse PFS (p = 0.04). Toxicities were low, with fracture rates of 0.3 % (acute) and 1.2 % (late).

Conclusion

Bone SBRT for OMPC is an effective treatment with low toxicity and particularly low fracture rates for both spine and non-spine BoM with no difference in outcome based on the localization. Prospective trials will help to identify the patients benefitting most from this approach and to establish standardized SBRT concepts incorporating systemic treatments.

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立体定向放射治疗前列腺癌脊柱和非脊柱骨转移——一项多中心队列分析

背景与目的转移性放射治疗在少转移性前列腺癌（OMPC）中发挥着越来越重要的作用。在这里，我们研究了立体定向体放疗（SBRT）在前列腺癌脊柱和非脊柱骨转移（BoM）中的作用。材料和方法这项来自五个三级癌症中心的多中心队列分析纳入了2010年至2024年间脊柱和非脊柱BoM辐照的患者数据。回顾性评估总生存期（OS）、无进展生存期（PFS）、局部无复发生存期（LRFS）、SBRT靶体积和剂量、毒性以及其他全身治疗的作用。结果共纳入231例患者（341例），中位随访时间28.3个月。最常见的定位是脊柱（39.3%）、骨盆骨（31.7%）和肋骨（17.9%）。脊柱BoM的1年和5年PFS分别为93.8% （95% CI:84.2 - 97.6%）和32.1% (95% CI:16.8 - 44.4%)，非脊柱BoM的PFS分别为91.7% （95% CI:85.1 - 95.5%）和36.6% （95% CI:25.8 - 47.5%）。脊柱BoM的1年和5年OS分别为94.2% （95% CI:85.3 - 97.8%）和69.2% (95% CI:50.2 - 82.2%)，非脊柱BoM的1年和5年OS分别为100%和73.3% （95% CI:59.1 - 83.3%）。年龄较大（p < 0.005）和额外的全身治疗（p = 0.05）与较差的OS相关，年龄较大和较大的治疗量与较差的PFS相关（p = 0.04）。毒性较低，骨折率为0.3%（急性）和1.2%（晚期）。结论骨SBRT治疗OMPC是一种低毒性、低骨折率的有效治疗方法，对脊柱和非脊柱BoM的治疗效果无差异。前瞻性试验将有助于确定从这种方法中获益最多的患者，并建立纳入全身治疗的标准化SBRT概念。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Bone Oncology ONCOLOGY-

CiteScore

7.20

自引率

2.90%

发文量

审稿时长

34 days

期刊介绍： The Journal of Bone Oncology is a peer-reviewed international journal aimed at presenting basic, translational and clinical high-quality research related to bone and cancer. As the first journal dedicated to cancer induced bone diseases, JBO welcomes original research articles, review articles, editorials and opinion pieces. Case reports will only be considered in exceptional circumstances and only when accompanied by a comprehensive review of the subject. The areas covered by the journal include: Bone metastases (pathophysiology, epidemiology, diagnostics, clinical features, prevention, treatment) Preclinical models of metastasis Bone microenvironment in cancer (stem cell, bone cell and cancer interactions) Bone targeted therapy (pharmacology, therapeutic targets, drug development, clinical trials, side-effects, outcome research, health economics) Cancer treatment induced bone loss (epidemiology, pathophysiology, prevention and management) Bone imaging (clinical and animal, skeletal interventional radiology) Bone biomarkers (clinical and translational applications) Radiotherapy and radio-isotopes Skeletal complications Bone pain (mechanisms and management) Orthopaedic cancer surgery Primary bone tumours Clinical guidelines Multidisciplinary care Keywords: bisphosphonate, bone, breast cancer, cancer, CTIBL, denosumab, metastasis, myeloma, osteoblast, osteoclast, osteooncology, osteo-oncology, prostate cancer, skeleton, tumour.