No pain no gain.

The Dutch PROSPECT cohort has prospectively collected data for patients treated with either conventional radiation or stereotactic body radiation (SBRT) for bone mets. Within PROSPECT was a randomized phase 2 study in which randomly selected patients with painful bone mets (including the spine) were offered SBRT. Conventional treatment was 8 Gy/1, 20 Gy/5, or 30 Gy/10. SBRT regimens were 18 Gy/1, 30 Gy/3, or 35 Gy/5. Randomized patients were allowed to decline SBRT, and surprisingly only 58% of patients offered SBRT ultimately received it. A common reason for choosing not to have SBRT was the time delay for more complex treatment planning. This left a relatively small cohort of patients (44 conventional, 26 SBRT), and at 3 months there was no significant difference in the rate of pain response with conventional RT (32%) compared to SBRT (46%). TBL: This trial did not demonstrate a significant improvement in pain response with SBRT over conventional palliative radiation for patients with painful spine and non-spine bone metastases. | Pielkenrood, Int J Radiat Oncol Biol Phys 2020