What a difference a day makes.

STAT RAD was a prospective trial at UVA that explored 1) the feasibility of single day, end-to-end palliative radiation for painful bone metastases, and 2) the safety and efficacy of dose escalation beyond 8 Gy. Patients had 1-3 painful bone mets that weren’t in long bones or causing bone instability. Single doses were escalated from 10 → 15 Gy for favorable prognosis (one-third of patients) and from 8 → 12.5 Gy for poor prognosis. In the end, over half of enrollees received 12.5 Gy x1. All patients were treated on the Tomotherapy platform, which means they had volume-based planning and optimization with either helical or static fields. While this technique is referred to as SBRT in the paper, the cost analysis appears to be based on the more likely billing label of 3D-CRT. At 12 weeks, 26% had complete pain relief, 39% had partial relief, 26% were stable, and 9% progressed. 17% required additional treatment at a median of 4.5 months. At 6 months, durable pain relief was seen in 69% (31% complete, 38% partial). There were no acute dose-limiting toxicities with dose escalation. TBL: Single-day end-to-end palliative radiation for painful bone metastases is safe and feasible, but an open question is whether moderate dose escalation above 8 Gy can provide more durable pain control. | Muller, Pract Radiat Oncol 2020