Unbreakable.

A Torontonian retrospective analysis reports outcomes for 106 non-spine bone mets treated with stereotactic body radiation (SBRT), typically 30 to 35 Gy in 5 fractions with a primary endpoint of radiographic recurrence. Yes, radiographic recurrence. At a median follow-up just shy of 10 months, 8 lesions (<8%) recurred at a median of 5 months, and 9 lesions (<9%) resulted in fracture at a median of 10 weeks. Side note: don’t get confused by the very confusing “mean” times used throughout the paper. Pain control was not assessed because, as the authors point out, most patients had low volume disease and were treated with higher doses solely to render them disease free. TBL: Bone SBRT outside the spine appears safe, but a phase 1 trial is more suitable to answer that question...and disease-free survival is a more suitable question. | Erler, Radiother Oncol 2018