The Role of Post-Operative Radiotherapy for Non-Spine Bone Metastases (NSBMs)
Abstract
:Simple Summary
Abstract
1. Introduction
Background
2. Evidence for Post-Operative Radiotherapy in Non-Spine Bone Metastases
2.1. Surgical Techniques and Fracture Type
2.2. Indications for Post-Operative Radiation Therapy—Local Control
2.3. External Beam Radiation Dose and Technique
2.3.1. Dose
2.3.2. Radiotherapy Target Volumes
2.4. Timing
2.5. Stereotactic Body Radiotherapy
2.6. Functional Status and Pain
2.7. Toxicity
2.8. Re-Irradiation
2.9. Clinical Example
3. Future Areas of Interest
4. Conclusions
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Ratasvuori, M.; Wedin, R.; Keller, J.; Nottrott, M.; Zaikova, O.; Bergh, P.; Kalen, A.; Nilsson, J.; Jonsson, H.; Laitinen, M. Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis. Surg. Oncol. 2013, 22, 132–138. [Google Scholar] [CrossRef]
- Soeharno, H.; Povegliano, L.; Choong, P.F. Multimodal Treatment of Bone Metastasis—A Surgical Perspective. Front. Endocrinol. 2018, 9, 518. [Google Scholar] [CrossRef] [Green Version]
- Capanna, R.; Campanacci, D.A. The Treatment of Metastases in the Appendicular Skeleton. J. Bone Jt. Surg. 2001, 83, 471–481. [Google Scholar] [CrossRef]
- Manabe, J.; Kawaguchi, N.; Matsumoto, S.; Tanizawa, T. Surgical treatment of bone metastasis: Indications and outcomes. Int. J. Clin. Oncol. 2005, 10, 103–111. [Google Scholar] [CrossRef]
- Bauer, H.C.F. Controversies in the surgical management of skeletal metastases. J. Bone Jt. Surg. 2005, 87, 608–617. [Google Scholar] [CrossRef] [PubMed]
- Mathis, N.J.; Doyle, C.J.; Rosen, D.B.; Wijetunga, N.A.; Vaynrub, M.; Bartelstein, M.; Guttmann, D.M.; Brennan, V.S.; Yamada, Y.J.; Gillespie, E.F.; et al. Personalized Treatment Selection Leads to Low Rates of Local Salvage Therapy for Bone Metastases. Int. J. Radiat. Oncol. 2022, 112, 99–105. [Google Scholar] [CrossRef] [PubMed]
- Ogilvie, C.M.; Fox, E.J.; Lackman, R.D. Current Surgical Management of Bone Metastases in the Extremities and Pelvis. Semin. Oncol. 2008, 35, 118–128. [Google Scholar] [CrossRef]
- Chow, R.; Hoskin, P.; Schild, S.E.; Raman, S.; Im, J.; Zhang, D.; Chan, S.; Chiu, N.; Chiu, L.; Lam, H.; et al. Single vs multiple fraction palliative radiation therapy for bone metastases: Cumulative meta-analysis. Radiother. Oncol. 2019, 141, 56–61. [Google Scholar] [CrossRef] [PubMed]
- Pin, Y.; Paix, A.; Le Fèvre, C.; Antoni, D.; Blondet, C.; Noël, G. A systematic review of palliative bone radiotherapy based on pain relief and retreatment rates. Crit. Rev. Oncol. 2018, 123, 132–137. [Google Scholar] [CrossRef]
- Ahmad, I.; Ahmed, M.M.; Ahsraf, M.F.; Naeem, A.; Tasleem, A.; Ahmed, M.; Farooqi, M.S. Pain Management in Metastatic Bone Disease: A Literature Review. Cureus 2018, 10, e3286. [Google Scholar] [CrossRef] [Green Version]
- Rich, S.E.; Chow, R.; Raman, S.; Zeng, K.L.; Lutz, S.; Lam, H.; Chow, E. Update of the systematic review of palliative radiation therapy fractionation for bone metastases. Radiother. Oncol. 2018, 126, 547–557. [Google Scholar] [CrossRef]
- Patchell, R.A.; Tibbs, P.A.; Regine, W.F.; Payne, R.; Saris, S.; Kryscio, R.J.; Mohiuddin, M.; Young, B. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomised trial. Lancet 2005, 366, 643–648. [Google Scholar] [CrossRef] [Green Version]
- van der Velden, J.; Willmann, J.; Spałek, M.; Oldenburger, E.; Brown, S.; Kazmierska, J.; Andratschke, N.; Menten, J.; van der Linden, Y.; Hoskin, P. ESTRO ACROP guidelines for external beam radiotherapy of patients with uncomplicated bone metastases. Radiother. Oncol. 2022, 173, 197–206. [Google Scholar] [CrossRef]
- Lutz, S.; Berk, L.; Chang, E.; Chow, E.; Hahn, C.; Hoskin, P.; Howell, D.; Konski, A.; Kachnic, L.; Lo, S.; et al. Palliative Radiotherapy for Bone Metastases: An ASTRO Evidence-Based Guideline. Int. J. Radiat. Oncol. 2011, 79, 965–976. [Google Scholar] [CrossRef]
- Lopez-Campos, F.; Cacicedo, J.; Couñago, F.; García, R.; Leaman-Alcibar, O.; Navarro-Martin, A.; Pérez-Montero, H.; Conde-Moreno, A. SEOR SBRT-SG stereotactic body radiation therapy consensus guidelines for non-spine bone metastasis. Clin. Transl. Oncol. 2022, 24, 215–226. [Google Scholar] [CrossRef]
- Damron, T.A.; Mann, K.A. Fracture Risk Assessment and Clinical Decision Making for Patients with Metastatic Bone Disease. J. Orthop. Res. 2020, 38, 1175–1190. [Google Scholar] [CrossRef]
- Mirels, H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin. Orthop. Relat. Res. 1989, 1989, 256–264. [Google Scholar] [CrossRef]
- Errani, C.; Mavrogenis, A.F.; Cevolani, L.; Spinelli, S.; Piccioli, A.; Maccauro, G.; Baldini, N.; Donati, D. Treatment for long bone metastases based on a systematic literature review. Eur. J. Orthop. Surg. Traumatol. 2017, 27, 205–211. [Google Scholar] [CrossRef]
- Sciubba, D.M.; Pennington, Z.; Colman, M.W.; Goodwin, C.R.; Laufer, I.; Patt, J.C.; Redmond, K.J.; Saylor, P.; Shin, J.H.; Schwab, J.H.; et al. Spinal metastases 2021: A review of the current state of the art and future directions. Spine J. 2021, 21, 1414–1429. [Google Scholar] [CrossRef] [PubMed]
- Moussazadeh, N.; Laufer, I.; Yamada, Y.; Bilsky, M.H. Separation Surgery for Spinal Metastases: Effect of Spinal Radiosurgery on Surgical Treatment Goals. Cancer Control. 2014, 21, 168–174. [Google Scholar] [CrossRef] [Green Version]
- Tao, R.; Bishop, A.J.; Brownlee, Z.; Allen, P.K.; Settle, S.H.; Chang, E.L.; Wang, X.; Amini, B.; Tannir, N.M.; Tatsui, C.; et al. Stereotactic Body Radiation Therapy for Spinal Metastases in the Postoperative Setting: A Secondary Analysis of Mature Phase 1-2 Trials. Int. J. Radiat. Oncol. 2016, 95, 1405–1413. [Google Scholar] [CrossRef]
- Laufer, I.; Iorgulescu, J.B.; Chapman, T.; Lis, E.; Shi, W.; Zhang, Z.; Cox, B.W.; Yamada, Y.; Bilsky, M.H. Local disease control for spinal metastases following “separation surgery” and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: Outcome analysis in 186 patients. J. Neurosurg. Spine 2013, 18, 207–214. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Faruqi, S.; Chen, H.; Fariselli, L.; Levivier, M.; Ma, L.; Paddick, I.; Pollock, B.E.; Regis, J.; Sheehan, J.; Suh, J.; et al. Stereotactic Radiosurgery for Postoperative Spine Malignancy: A Systematic Review and International Stereotactic Radiosurgery Society Practice Guidelines. Pr. Radiat. Oncol. 2022, 12, e65–e78. [Google Scholar] [CrossRef]
- Van Geffen, E.; Wobbes, T.; Veth, R.P.H.; Gelderman, W.A.H. Operative Management of Impending Pathological Fractures: A Critical Analysis of Therapy. J. Surg. Oncol. 1997, 64, 190–194. [Google Scholar] [CrossRef]
- Adamietz, I.A.; Wolanczyk, M.J. Functional recovery after surgical stabilization and postoperative radiotherapy due to metastases of long bones. Strahlenther. Onkol. 2018, 195, 335–342. [Google Scholar] [CrossRef] [Green Version]
- Epstein-Peterson, Z.D.; Sullivan, A.; Krishnan, M.; Chen, J.T.; Ferrone, M.; Ready, J.; Baldini, E.H.; Balboni, T. Postoperative radiation therapy for osseous metastasis: Outcomes and predictors of local failure. Pract. Radiat. Oncol. 2015, 5, e531–e536. [Google Scholar] [CrossRef]
- Townsend, P.W.; Smalley, S.R.; Cozad, S.C.; Rosenthal, H.G.; Hassanein, R.E. Role of postoperative radiation therapy after stabilization of fractures caused by metastatic disease. Int. J. Radiat. Oncol. Biol. Phys. 1995, 31, 43–49. [Google Scholar] [CrossRef]
- Drost, L.; Ganesh, V.; Wan, B.A.; Raman, S.; Chan, S.; Christakis, M.; Tsao, M.; Barnes, E.; Ford, M.; Finkelstein, J.; et al. Efficacy of postoperative radiation treatment for bone metastases in the extremities. Radiother. Oncol. 2017, 124, 45–48. [Google Scholar] [CrossRef]
- Rosen, D.B.; Haseltine, J.M.; Bartelstein, M.; Flynn, J.R.; Zhang, Z.; Kohutek, Z.A.; Yamada, Y.; Schmitt, A.; Higginson, D.S.; Vaynrub, M.; et al. Should Postoperative Radiation for Long Bone Metastases Cover Part or All of the Orthopedic Hardware? Results of a Large Retrospective Analysis. Adv. Radiat. Oncol. 2021, 6, 100756. [Google Scholar] [CrossRef]
- Nguyen, T.K.; Sahgal, A.; Dagan, R.; Eppinga, W.; Guckenberger, M.; Kim, J.H.; Lo, S.S.; Redmond, K.J.; Siva, S.; Stish, B.J.; et al. Stereotactic Body Radiation Therapy for Nonspine Bone Metastases: International Practice Patterns to Guide Treatment Planning. Pract. Radiat. Oncol. 2020, 10, e452–e460. [Google Scholar] [CrossRef]
- Ito, K.; Nakajima, Y.; Onoe, T.; Ogawa, H.; Harada, H.; Saito, M.; Karasawa, K. Phase 2 Clinical Trial of Stereotactic Body Radiation Therapy for Painful Nonspine Bone Metastases. Pract. Radiat. Oncol. 2021, 11, e139–e145. [Google Scholar] [CrossRef]
- De la Pinta, C. SBRT in non-spine bone metastases: A literature review. Med. Oncol. 2020, 37, 119. [Google Scholar] [CrossRef]
- Elhammali, A.; Milgrom, S.A.; Amini, B.; Gunther, J.R.; Yoder, A.; Ludmir, E.B.; Dabaja, B.S. Postoperative Radiotherapy for Multiple Myeloma of Long Bones: Should the Entire Rod Be Treated? Clin. Lymphoma Myeloma Leuk. 2019, 19, e465–e469. [Google Scholar] [CrossRef] [PubMed]
- Kubota, H.; Nakamura, N.; Shikama, N.; Tonari, A.; Wada, H.; Harada, H.; Nagakura, H.; Heianna, J.; Ito, K.; Nozaki, M.; et al. Practice patterns for postoperative radiation therapy in patients with metastases to the long bones: A survey of the Japanese Radiation Oncology Study Group. J. Radiat. Res. 2021, 62, 356–363. [Google Scholar] [CrossRef] [PubMed]
- Willeumier, J.J.; van der Linden, Y.M.; Dijkstra, P.S. Lack of clinical evidence for postoperative radiotherapy after surgical fixation of impending or actual pathologic fractures in the long bones in patients with cancer; a systematic review. Radiother. Oncol. 2016, 121, 138–142. [Google Scholar] [CrossRef] [PubMed]
- Piccioli, A.; Rossi, B.; Scaramuzzo, L.; Spinelli, M.S.; Yang, Z.; Maccauro, G. Intramedullary nailing for treatment of pathologic femoral fractures due to metastases. Injury 2014, 45, 412–417. [Google Scholar] [CrossRef]
- Madani, I.; Sahgal, A.; Erler, D.; Stish, B.J.; Olivier, K.R.; Park, S.S.; Eppinga, W.; Seravalli, E.; Redmond, K.J.; Cao, Y.; et al. Stereotactic Body Radiation Therapy for Metastases in Long Bones. Int. J. Radiat. Oncol. 2022, 114, 738–746. [Google Scholar] [CrossRef]
- Spencer, K.L.; van der Velden, J.M.; Wong, E.; Seravalli, E.; Sahgal, A.; Chow, E.; Verlaan, J.-J.; Verkooijen, H.M.; van der Linden, Y.M. Systematic Review of the Role of Stereotactic Radiotherapy for Bone Metastases. Gynecol. Oncol. 2019, 111, 1023–1032. [Google Scholar] [CrossRef]
- McQuay, H.J.; Collins, S.L.; Carroll, D.; Moore, R.A.; Derry, S. Radiotherapy for the Palliation of Painful Bone Metastases; John Wiley and Sons Ltd.: Hoboken, NJ, USA, 2013. [Google Scholar]
- De Felice, F.; Piccioli, A.; Musio, D.; Tombolini, V. The Role of Radiation Therapy in Bone Metastases Management. Volume 8, Oncotarget. 2017. Available online: www.impactjournals.com/oncotarget/ (accessed on 1 May 2023).
- Correia, D.; Moullet, B.; Cullmann, J.; Heiss, R.; Ermiş, E.; Aebersold, D.M.; Hemmatazad, H. Response assessment after stereotactic body radiation therapy for spine and non-spine bone metastases: Results from a single institutional study. Radiat. Oncol. 2022, 17, 37. [Google Scholar] [CrossRef]
- Chow, E.; Ling, A.; Davis, L.; Panzarella, T.; Danjoux, C. Pain flare following external beam radiotherapy and meaningful change in pain scores in the treatment of bone metastases. Radiother. Oncol. 2005, 75, 64–69. [Google Scholar] [CrossRef]
- Wong, E.; Hoskin, P.; Bedard, G.; Poon, M.; Zeng, L.; Lam, H.; Vulpe, H.; Tsao, M.; Pulenzas, N.; Chow, E. Re-irradiation for painful bone metastases—A systematic review. Radiother. Oncol. 2014, 110, 61–70. [Google Scholar] [CrossRef] [PubMed]
- Huisman, M.; Verkooijen, H.; van der Linden, Y.; Bosch, M.V.D.; van Vulpen, M. Effectiveness of Repeat Radiotherapy for Painful Bone Metastases in Clinical Practice: A 10 Year Historical Cohort Study. Clin. Oncol. 2015, 27, 472–478. [Google Scholar] [CrossRef] [PubMed]
- Huisman, M.; Bosch, M.A.v.D.; Wijlemans, J.W.; van Vulpen, M.; van der Linden, Y.M.; Verkooijen, H.M. Effectiveness of Reirradiation for Painful Bone Metastases: A Systematic Review and Meta-Analysis. Int. J. Radiat. Oncol. 2012, 84, 8–14. [Google Scholar] [CrossRef] [PubMed]
- ClinicalTrials.gov Identifier: NCT02705183. Post-Operative RadioTherapy for Patients with Metastases of the Long Bones (PORT). Available online: https://clinicaltrials.gov/ct2/show/NCT02705183 (accessed on 6 April 2023).
- ClinicalTrials.gov Identifier: NCT04109937. External Beam Radiation Therapy Post Surgery in Patients with Lower Extremity Bone Metastases Randomized Efficacy Trial (EXPLORE). Available online: https://clinicaltrials.gov/ct2/show/NCT04109937?cond=post-operative+bone+radiotherapy&draw=2&rank=2 (accessed on 6 April 2023).
Score | |||
---|---|---|---|
1 | 2 | 3 | |
Location | Upper extremity | Lower extremity | Periotrochanteric region |
Pain | Mild | Moderate | Severe |
Lesion | Blastic | Mixed | Lytic |
Size | <1/3 of bone width | 1/3 to 2/3 of bone width | >2/3 of bone width |
Fracture risk | Recommendation | ||
Total Score | ≤7 | 0–4% | Safe to irradiate with minimal risk of fracture |
8 | 15% | Consider prophylactic fixation | |
≥9 | >33% | Prophylactic fixation indicated |
Study | Rosen et al., 2021 [29] | Adamietz Wolanczyk, 2018 [25] | Drost et al., 2017 [28] | Epstein Peterson et al., 2015 [26] | Van Geffen et al., 1997 ** [24] | Townsend et al., 1995 [27] |
---|---|---|---|---|---|---|
Study Design | Retrospective | Retrospective | Retrospective | Retrospective | Retrospective | Retrospective |
Number of Lesions | n = 145 | n = 68 | n = 74 | n = 52 | n = 27 | n = 35 |
Location | Long Bones | - FE (81%) - HU (19%) | - FE (79.7%) - HU (13.5%) - Knee (6.8%) | - LE (46%) - UE (17%) - Spine (37%) | - FE (59%) - HU (20%) - Spine (8%) - Pelvis (7%) | - FE (91%) - HU (6%) |
Operative Technique | IM (77%) Plate (23%) | IM (55.8%) Plate (44.1%) | Surgical Fixation | ORIF (13%) IM (45%) Spine (37%) | IM (23%) Plate (51%) Other (20%) | NR |
Radiation Dose | EBRT (92%) (20–30 Gy) SBRT (8%) | EBRT (Mean) (34 Gy/7.8) | EBRT (30/10, 20/5, 8/1, other) | EBRT (30/10, 20/5, 24/6, 8/1) | NR | EBRT (30–45 Gy) |
Fracture Type | - PF and IF | - PF (70.5%) - IF (30%) | - PF and IF | - PF (54%) - IF (24%) - No # (17%) | - IF (100%) | - PF (51%) - IF (49%) |
Local Control | 70% | 95.6% | 83% | 83% | 20% | 91.2% |
Hardware Coverage | 52% | 52.9% | 97.3% | 26% | NR | 39% |
OS (mean months) | NR | 16.3 | NR | 6.7 | 15 | PORT 12 None 3.3 |
Pain /Function | NR | Normal Function (93%) | General Improvement | NR | Improved Function (79%) Pain-free (60%) | Normal Function (51%) |
Toxicity | NR | NR | NR | Local (17%) | Local (14%) | NR |
Follow-up (median months) | 29.5 | 16.3 | NR | 11.5 | NR | 10.7 |
Time from operation to radiation (mean days) | 41 | 33.6 | NR | 20 | NR | 14 |
Study | Key Findings |
---|---|
Rosen et al., 2021 [29] |
|
Adamietz and Wolanczyk, 2018 [25] |
|
Drost et al., 2017 [28] |
|
Epstein-Peterson et al., 2015 [26] |
|
Van Geffen et al., 1997 [24] |
|
Townsend et al., 1995 [27] |
|
Study | Study Type | Radiation Type | Summary |
---|---|---|---|
Lopez et al., 2022 [15] | Guideline (Not PORT) | SBRT |
|
Nguyen et al., 2022 [30] | Guideline | SBRT |
|
Ito et al., 2021 [31] | Prospective (Not PORT) | SBRT |
|
Pinta et al., 2020 [32] | Literature Review | SBRT |
|
Kubota et al., 2020 [34] | Survey | EBRT |
|
Elhammali et al., 2019 [33] | Retrospective | EBRT |
|
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Ramadan, S.; Arifin, A.J.; Nguyen, T.K. The Role of Post-Operative Radiotherapy for Non-Spine Bone Metastases (NSBMs). Cancers 2023, 15, 3315. https://doi.org/10.3390/cancers15133315
Ramadan S, Arifin AJ, Nguyen TK. The Role of Post-Operative Radiotherapy for Non-Spine Bone Metastases (NSBMs). Cancers. 2023; 15(13):3315. https://doi.org/10.3390/cancers15133315
Chicago/Turabian StyleRamadan, Sherif, Andrew J. Arifin, and Timothy K. Nguyen. 2023. "The Role of Post-Operative Radiotherapy for Non-Spine Bone Metastases (NSBMs)" Cancers 15, no. 13: 3315. https://doi.org/10.3390/cancers15133315
APA StyleRamadan, S., Arifin, A. J., & Nguyen, T. K. (2023). The Role of Post-Operative Radiotherapy for Non-Spine Bone Metastases (NSBMs). Cancers, 15(13), 3315. https://doi.org/10.3390/cancers15133315