Compressed.

Spine radiosurgery (SRS) suffered a blow with initial reporting of RTOG 0631 that demonstrated no advantage in pain control at 3 months when compared to conventional treatment. Here we bring you the first meta-analysis comparing single-fraction SRS (44%), multi-fraction SRS (20%), and conventional treatment (36%) of nearly 5K spine mets across 37 studies with primary endpoints of local control and toxicity. In a comeback win (primarily due to choice of endpoint), single-fraction SRS achieved superior local control at one year (>95%) compared to both multi-fraction SRS (82%) and conventional treatment (81%). What’s more, rates of grade 3+ toxicities were far below 1% across the board. One thing to note, though, is that rate of vertebral compression fracture was much higher with single-fraction SRS (20%) than otherwise (<10%). TBL: Pooling multiple studies, single-fraction SRS results in superior local control at the expense of a fairly high rate of vertebral compression fracture. | Singh, Radiother Oncol 2020