Topics:
Radiation Oncology • Palliation
How have the results of the phase III RTOG 0631 trial impacted your use of spine SBRT?
In the phase III RTOG 0631 trial, patients with 1 to 3 vertebral metastases were randomized 2:1 to either SRS (16 or 18 Gy in 1 fraction) or cEBRT (8 Gy given to the involved vertebra plus 1 additional vertebra above and below in a single fraction). The primary end point of pain response at 3 months favored cEBRT (41.3% for SRS vs 60.5% for cEBRT; p=0.01)
Given the results of this trial, do you routinely offer spine SBRT for palliation?
If so, what dose/fractionation scheme do you prefer to employ, and why?
Answer from: Radiation Oncologist at Academic Institution
NRG/RTOG and the investigators are commendable for completing this important trial and reporting the outcomes. The possible reasons for the negative results of the SBRT arm were discussed in the plenary session at ASTRO 2019 and in the Discussion section of the JAMA Oncol paper by the authors. This ...
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Answer from: Radiation Oncologist at Community Practice
To answer the question directly, yes, I do still offer SBRT for vertebral mets. It is important to note, the RTOG 0631 recently published was for denovo spine mets. It is an important dataset esp given the question at hand. However, my approach to spine SRS has been with the following criteria:
Pri...