Pavan Jhaveri BS, Abstract Co-Author: Nothing to Disclose

Bin Sing Teh MD, Abstract Co-Author: Nothing to Disclose

Brian Butler, Presenter: Nothing to Disclose

Arnold C. Dela Paulino MD, Abstract Co-Author: Nothing to Disclose

To evaluate the utility of SBRT in the treatment of painful bone metastases, including "radioresistant" RCC metastases

51 patients with metastatic lesions in the spine, pelvis, ribs and extremities were treated with SBRT using the BrainLAB Novalis stereotactic system from 4/04 to 3/06. The most common regimen was 24 Gy in 3 fractions (8 Gy per fraction). Evaluation was done on the relief of acute pain secondary to tumor and time to recurrence. Mean follow up was 11.5 weeks (4-100 weeks). Pain was rated by the 10 point Wong-Baker Faces scale. A complete symptomatic response was defined as a 0 or 1 out of 10 after treatment. A partial symptomatic response was defined as a drop in the pain score by at least two points after treatment. Use of pain medication was controlled for. A subset analysis was done on 30/51 lesions of RCC primary.

Pain control (Overall) A stable pain score was achieved in 10.4 days (mean) after treatment completion. 51% and 41.2% of all cases had a complete and partial symptomatic response respectively. Overall, 92.2% of cases had a reduction in pain. Recurrence of pain (Overall) 11.8% of cases had a recurrence during the follow up period, which was defined as an increase in pain score after achieving partial or complete symptomatic response. The average time to symptomatic recurrence after SBRT completion was 80.5 days. No significant treatment-related side effects were seen. Renal Cell Carcinoma Subset A stable pain score was achieved in 14.8 days (mean). 43.3% and 50% of cases had a complete and partial resolution of bone pain respectively. Overall, 93.3% of the cases with RCC had a reduction in pain. 13.3% of RCC cases developed a symptomatic recurrence during the follow up period, at an average of 73.5 days after SBRT completion.    

SBRT can be used to treat painful bony metastases effectively. When compared to historic controls, the potential advantages of SBRT over conventional radiotherapy included the ability to provide faster pain relief, biologically more potent dose without increased side-effects as well as shorter treatment duration with a fewer number of fractions. SBRT is also effective in treating more radioresistant tumors like metastatic RCC.  

SBRT can be used to deliver ablative doses for more durable pain relief. It is also useful for previously irradiated sites and "radioresistant" cancer.

Jhaveri, P, Teh, B, Butler, B, Paulino, A, Stereotactic Body Radiotherapy (SBRT) Is Successful in Treating Acute Metastatic Bone Pain including "Radioresistant" Renal Cell Carcinoma (RCC).  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6015040.html