Tanja Sprave

Intensity-modulated proton therapy, volumetric-modulated arc therapy, and 3D conformal radiotherapy in anaplastic astrocytoma and glioblastoma

PurposeThe prognosis for high-grade glioma (HGG) patients is poor; thus, treatment-related side effects need to be minimized to conserve quality of life and functionality. Advanced techniques such as proton radiation therapy (PRT) and volumetric-modulated arc therapy (VMAT) may potentially further reduce the frequency and severity of radiogenic impairment.Materials and methodsWe retrospectively assessed 12 HGG patients who had undergone postoperative intensity-modulated proton therapy (IMPT). VMAT and 3D conformal radiotherapy (3D-CRT) plans were generated and optimized for comparison after contouring crucial neuronal structures important for neurogenesis and neurocognitive function. Integral dose (ID), homogeneity index (HI), and inhomogeneity coefficient (IC) were calculated from dose statistics. Toxicity data were evaluated.ResultsTarget volume coverage was comparable for all three modalities. Compared to 3D-CRT and VMAT, PRT showed statistically significant reductions (pxa0< 0.05) in mean dose to whole brain (−20.2xa0%, −22.7xa0%); supratentorial (−14.2xa0%, −20,8xa0%) and infratentorial (−91.0xa0%, −77.0xa0%) regions; brainstem (−67.6xa0%, −28.1xa0%); pituitary gland (−52.9xa0%, −52.5xa0%); contralateral hippocampus (−98.9xa0%, −98.7xa0%); and contralateral subventricular zone (−62.7xa0%, −66.7xa0%, respectively). Fatigue (91.7xa0%), radiation dermatitis (75.0xa0%), focal alopecia (100.0u2009%), nausea (41.7u2009%), cephalgia (58.3u2009%), and transient cerebral edema (16.7u2009%) were the most common acute toxicities.ConclusionEssential dose reduction while maintaining equal target volume coverage was observed using PRT, particularly in contralaterally located critical neuronal structures, areas of neurogenesis, and structures of neurocognitive functions. These findings were supported by preliminary clinical results confirming the safety and feasibility of PRT in HGG.ZusammenfassungZielsetzungDie Prognose bei „High-grade“-Gliomen (HGG) ist infaust. Gerade bei diesen Patienten sollten therapieassoziierte Nebenwirkungen minimiert werden, um die Lebensqualität und Funktionalität zu erhalten. Moderne Radiotherapietechniken, wie die Protonenradiotherapie (PRT) und die volumenmodulierte Arc-Therapie (VMAT), haben das Potential, die Dosisbelastung von Risikoorganen weiter zu reduzieren.Material und Methoden12xa0HGG-Patienten, die eine postoperative intensitätsmodulierten Protonentherapie (IMPT) erhalten hatten, wurden retrospketiv bewertet. Zum Vergleich wurden VMAT- und 3D-konformale Radiotherapiepläne (3D-CRT) generiert, in denen die Dosisverteilung in wichtigen Arealen der Neurogenese und neurokognitiven Funktion bestimmt wurden. Anhand von Dosisstatistiken wurden die Integraldosis (ID), der Homogenitätsindex (HI) und der Inhomogenitätskoeffizient (IC) berechnet und die therapieassoziierte Toxizität bestimmt.ErgebnisseFür alle drei Techniken war die Zielvolumenabdeckung vergleichbar gut. PRT reduzierte die Dmean im Vergleich zur 3D-CRT und VMAT im Ganzhirn (−20,2u2009%; −22,7u2009%), im supratentoriellen (−14,2u2009%; −20,8u2009%) und infratentoriellen Hirn (−91u2009%; −77,0u2009%), im Hirnstamm (−67,6u2009%; −28,u2009%), in der Hypophyse (−52,9u2009%; −52,5u2009%), im kontralateralen Hippokampus (−98,9u2009%; −98,7u2009%) und in der kontralateralen subventrikulären Zone (−62,7u2009%; −66,7u2009%) signifikant (pxa0< 0,05). Die häufigsten akuten Nebenwirkungen waren Fatigue (91,7u2009%), radiogene Dermatitis (75,0u2009%), fokale Alopezie (100,0u2009%), Nausea (41,7u2009%), Cephalgien (58,3u2009%) und vorübergehende zerebrale Ödeme (16,7u2009%).SchlussfolgerungDurch die PRT konnte bei Aufrechterhaltung der Zielvolumenabdeckung eine signifikante Dosisreduktion insbesondere in kontralateralen kritischen neuronalen Strukturen sowie in essentiellen Arealen für die neurokognitiven Funktionen und Neurogenese beobachtet werden. Die vorläufigen klinischen Ergebnisse bestätigen die sichere Durchführbarkeit und Praktikabilität der PRT bei HGG.

Intensity-modulated proton therapy, volumetric-modulated arc therapy, and 3D conformal radiotherapy in anaplastic astrocytoma and glioblastoma : A dosimetric comparison.

PurposeThe prognosis for high-grade glioma (HGG) patients is poor; thus, treatment-related side effects need to be minimized to conserve quality of life and functionality. Advanced techniques such as proton radiation therapy (PRT) and volumetric-modulated arc therapy (VMAT) may potentially further reduce the frequency and severity of radiogenic impairment.Materials and methodsWe retrospectively assessed 12 HGG patients who had undergone postoperative intensity-modulated proton therapy (IMPT). VMAT and 3D conformal radiotherapy (3D-CRT) plans were generated and optimized for comparison after contouring crucial neuronal structures important for neurogenesis and neurocognitive function. Integral dose (ID), homogeneity index (HI), and inhomogeneity coefficient (IC) were calculated from dose statistics. Toxicity data were evaluated.ResultsTarget volume coverage was comparable for all three modalities. Compared to 3D-CRT and VMAT, PRT showed statistically significant reductions (pxa0< 0.05) in mean dose to whole brain (−20.2xa0%, −22.7xa0%); supratentorial (−14.2xa0%, −20,8xa0%) and infratentorial (−91.0xa0%, −77.0xa0%) regions; brainstem (−67.6xa0%, −28.1xa0%); pituitary gland (−52.9xa0%, −52.5xa0%); contralateral hippocampus (−98.9xa0%, −98.7xa0%); and contralateral subventricular zone (−62.7xa0%, −66.7xa0%, respectively). Fatigue (91.7xa0%), radiation dermatitis (75.0xa0%), focal alopecia (100.0u2009%), nausea (41.7u2009%), cephalgia (58.3u2009%), and transient cerebral edema (16.7u2009%) were the most common acute toxicities.ConclusionEssential dose reduction while maintaining equal target volume coverage was observed using PRT, particularly in contralaterally located critical neuronal structures, areas of neurogenesis, and structures of neurocognitive functions. These findings were supported by preliminary clinical results confirming the safety and feasibility of PRT in HGG.ZusammenfassungZielsetzungDie Prognose bei „High-grade“-Gliomen (HGG) ist infaust. Gerade bei diesen Patienten sollten therapieassoziierte Nebenwirkungen minimiert werden, um die Lebensqualität und Funktionalität zu erhalten. Moderne Radiotherapietechniken, wie die Protonenradiotherapie (PRT) und die volumenmodulierte Arc-Therapie (VMAT), haben das Potential, die Dosisbelastung von Risikoorganen weiter zu reduzieren.Material und Methoden12xa0HGG-Patienten, die eine postoperative intensitätsmodulierten Protonentherapie (IMPT) erhalten hatten, wurden retrospketiv bewertet. Zum Vergleich wurden VMAT- und 3D-konformale Radiotherapiepläne (3D-CRT) generiert, in denen die Dosisverteilung in wichtigen Arealen der Neurogenese und neurokognitiven Funktion bestimmt wurden. Anhand von Dosisstatistiken wurden die Integraldosis (ID), der Homogenitätsindex (HI) und der Inhomogenitätskoeffizient (IC) berechnet und die therapieassoziierte Toxizität bestimmt.ErgebnisseFür alle drei Techniken war die Zielvolumenabdeckung vergleichbar gut. PRT reduzierte die Dmean im Vergleich zur 3D-CRT und VMAT im Ganzhirn (−20,2u2009%; −22,7u2009%), im supratentoriellen (−14,2u2009%; −20,8u2009%) und infratentoriellen Hirn (−91u2009%; −77,0u2009%), im Hirnstamm (−67,6u2009%; −28,u2009%), in der Hypophyse (−52,9u2009%; −52,5u2009%), im kontralateralen Hippokampus (−98,9u2009%; −98,7u2009%) und in der kontralateralen subventrikulären Zone (−62,7u2009%; −66,7u2009%) signifikant (pxa0< 0,05). Die häufigsten akuten Nebenwirkungen waren Fatigue (91,7u2009%), radiogene Dermatitis (75,0u2009%), fokale Alopezie (100,0u2009%), Nausea (41,7u2009%), Cephalgien (58,3u2009%) und vorübergehende zerebrale Ödeme (16,7u2009%).SchlussfolgerungDurch die PRT konnte bei Aufrechterhaltung der Zielvolumenabdeckung eine signifikante Dosisreduktion insbesondere in kontralateralen kritischen neuronalen Strukturen sowie in essentiellen Arealen für die neurokognitiven Funktionen und Neurogenese beobachtet werden. Die vorläufigen klinischen Ergebnisse bestätigen die sichere Durchführbarkeit und Praktikabilität der PRT bei HGG.

Randomized phase II trial evaluating pain response in patients with spinal metastases following stereotactic body radiotherapy versus three-dimensional conformal radiotherapy

BACKGROUNDnTo report the primary endpoint of a randomized trial comparing pain response following palliative stereotactic body radiation therapy (SBRT) versus conventionally-fractionated 3D-conformal radiotherapy (3DCRT) for previously untreated spinal metastases.nnnMETHODSnFifty-five patients with histologically/radiologically confirmed painful spinal metastases were analyzed in this single-institutional, non-blinded, randomized explorative trial. Participants were randomly assigned (1:1) to receive single-fraction SBRT (24u202fGy) or 3DCRT (30u202fGy in 10 fractions). The primary endpoint was pain relief of >2 points on the visual analog scale (VAS) measured within the irradiated region at 3u202fmonths following radiotherapy completion. Other recorded parameters included pain response (per International Bone Consensus response definitions), use of concurrent medications and opioid usage (oral morphine equivalent dose, OMED). All parameters were assessed at baseline and at three and six months after RT. Intention-to-treat analysis was applied. This trial is registered with ClinicalTrials.gov, number NCT02358720.nnnFINDINGSnDespite no significant differences for VAS at 3u202fmonths between groups (pu202f=u202f0.13), pain values decreased faster within this time period in the SBRT arm (pu202f=u202f0.01). At 6u202fmonths following RT, significantly lower VAS values were reported in the SBRT group (pu202f=u202f0.002). There were no differences in OMED consumption at 3 (pu202f=u202f0.761) and 6u202fmonths (pu202f=u202f0.174). There was a trend toward improved pain response in the SBRT arm at 3u202fmonths (pu202f=u202f0.057), but significantly so after 6u202fmonths (pu202f=u202f0.003). No patient in the SBRT group experienced grade ≥3 toxicities according to the Common Terminology Criteria for Adverse Events v.4.03.nnnCONCLUSIONSnThis randomized trial demonstrates the utility of palliative SBRT for spinal metastases, which was associated with a quicker and improved pain response. Larger ongoing randomized studies will assist in further addressing these endpoints.

Stability of Spinal Bone Lesions in Patients With Multiple Myeloma After Radiotherapy—A Retrospective Analysis of 130 Cases

Micro‐Abstract This retrospective analysis evaluated the response regarding bone density and stability of patients with osteolytic spinal bone lesions due to multiple myeloma after palliative radiotherapy. The rate of unstable lesions decreased from 51% to 24%, and the bone density showed a significant increase 6 months after radiotherapy. Palliative radiotherapy is an effective method resulting in a significant increase for local response and stability without severe RT‐related toxicity. Background: The objective of the present retrospective analysis was the response evaluation regarding bone density and stability of patients with osteolytic spinal bone lesions due to multiple myeloma after palliative radiotherapy (RT). Patients and Methods: Patients with multiple myeloma who had undergone spinal RT from March 2003 to May 2016 were analyzed before and 3 and 6 months after RT. Assessment of spinal stability and bone density was performed using the internationally recognized Taneichi scoring system and measurement of bone density using computed tomography imaging‐based Hounsfield units. For statistical analysis, we used the Bowker test, McNemar test, and &kgr; statistics to detect possible asymmetries in the distribution of the Taneichi score over time. We used the Student t test for comparison of the density values (Hounsfield units) before and after treatment. Toxicity was evaluated using the Common Terminology Criteria for Adverse Events, version 4.0. Additionally, overall survival was calculated using the Kaplan‐Meier method. Results: We evaluated 130 patients (69% male; 31% female) with multiple myeloma and a median age of 58 years. The median follow‐up period was 41 months. Before treatment, 51% of the lesions were classified as unstable. At 3 and 6 months after RT, this rate had decreased to 41% (P = .0047) and 24% (P = .2393), respectively. The computed tomography measurements showed a significant increase in bone density at 3 and 6 months after RT. Acute RT‐related grade 1 and 2 complications were detected in 34% of patients. Late side effects (grade 1‐2) were detected in 23% of the patients. No severe grade 3 or 4 acute or late toxicities were identified. The median overall survival was 19.7 months for all patients and 6.6 months for patients with a Karnofsky performance score of ≤ 70%. Conclusion: To the best of our knowledge, ours is the first report to analyze the bone density and stability in patients with multiple myeloma after RT using a validated scoring system and computed tomography imaging. Palliative RT is an effective method resulting in a significant increase in bone density for local response and stability without severe RT‐related toxicity. Furthermore, recalcification could already be detected at 3 months after treatment.

Intensity-modulated radiotherapy with integrated-boost in patients with bone metastasis of the spine: study protocol for a randomized controlled trial

BackgroundStereotactic body radiation therapy (SBRT) using intensity-modulated radiotherapy (IMRT) with dose escalation by simultaneous integrated boost (SIB) can be a safe modality for treating spinal bone metastases with enhanced targeting accuracy and improve local tumor control.Methods/DesignThis is a single-center, prospective, randomized, controlled trial. One hundred and twenty patients with spinal bone metastases will receive palliative radiation therapy at the Heidelberg University Hospital. SBRT will be given in five or ten fractions with or without SIB. Four treatment arms are planned: IMRT with 30xa0Gy in ten fractions, IMRT with 30xa0Gy in ten fractions and SIB to 40xa0Gy, IMRT with 20xa0Gy in five fractions, and IMRT with 20xa0Gy in five fractions and SIB to 30Gy in five fractions will be compared. The target parameters will be measured at baseline level and at three and six months after radiation.DiscussionThe primary endpoint of this study was to assess and compare the local tumor control (by means of different fractionation schedules and biological doses to the tumor area). Secondary endpoints are acute and chronic adverse events, pain relief, quality of life, and fatigue.Trial registrationClinicalTrials.gov, NCT02832765. Registered on 27 July 2016.

Radiation-induced toxicity after image-guided and intensity-modulated radiotherapy versus external beam radiotherapy for patients with spinal bone metastases (IRON-1): a study protocol for a randomized controlled pilot trial

BackgroundRadiation therapy (RT) of bone metastases provides an important treatment approach in palliative care treatment concepts. As a consequence of treatment, the extent of radiation-induced toxicity is a crucial feature with consequences to a patient’s quality of life. In this context this study aims at reducing the extent of radiation-induced side effects and toxicity by assuming a better sparing of normal tissue with the use of intensity-modulated instead of conventionally delivered external beam radiotherapy.Methods/designIn this prospective, randomized, single-center trial for patients with spinal bone metastases, RT is performed as either image-guided intensity-modulated radiotherapy (10x3Gy) or conventionally fractionated external beam radiotherapy (10x3Gy). Afterwards radiation-induced toxicity will be assessed and compared 3 and 6 months after the end of radiation.DiscussionThe aim of this pilot study is the evaluation of achievable benefits, with reduced radiation toxicity being the primary endpoint in the comparison of intensity-modulated radiotherapy versus conventional radiotherapy for patients with spinal bone metastases. Secondarily, bone re-calcification, quality of life, pain relief, spinal instability, and local control will be measured and compared between the two treatment groups.Trial registrationClinicalTrials.gov, NCT02832830. Registered on 12 July 2016.

Differentiated resistance training of the paravertebral muscles in patients with unstable spinal bone metastasis under concomitant radiotherapy: study protocol for a randomized pilot trial

BackgroundMetastatic bone disease is a common and severe complication in patients with advanced cancer. Radiotherapy (RT) has long been established as an effective local treatment for metastatic bone disorder. This study assesses the effects of RT combined with muscle-training exercises in patients with unstable bone metastases of the spinal column from solid tumors. The primary goal of this study is to evaluate the feasibility of muscle-training exercises concomitant to RT. Secondly, quality of life, fatigue, overall and bone survival, and local control will be assessed.Methods/DesignThis study is a single-center, prospective, randomized, controlled, explorative intervention study with a parallel-group design to determine multidimensional effects of a course of exercises concomitant to RT on patients who have unstable metastases of the vertebral column, first under therapeutic instruction and subsequently performed by the patients themselves independently for strengthening the paravertebral muscles. On the days of radiation treatment the patients will be given four different types of exercises to ensure even isometric muscle training of all the spinal muscles. In the control group progressive muscle relaxation will be carried out parallel to RT. The patients will be randomized into two groups: differentiated muscle training or progressive muscle relaxation with 30 patients in each group.DiscussionDespite the clinical experience that RT is an effective treatment for bone metastases, there is insufficient evidence for a positive effect of the combination with muscle-training exercises in patients with unstable bone metastases. Our previous DISPO-1 trial showed that adding muscle-training exercises to RT is feasible, whereas this was not proven in patients with an unstable spinal column. Although associated with several methodological and practical challenges, this randomized controlled trial is needed.Trial registrationClinicalTrials.gov, identifier: NCT02847754. Registered on 27 July 2016.

Radiation-induced acute toxicities after image-guided intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for patients with spinal metastases (IRON-1 trial)

PurposeRadiation therapy (RT) provides an important treatment approach in the palliative care of vertebral metastases, but radiation-induced toxicities in patients with advanced disease and low performance status can have substantial implications for quality of life. Herein, we prospectively compared toxicity profiles of intensity-modulated radiotherapy (IMRT) vs. conventional three-dimensional conformal radiotherapy (3DCRT).MethodsThis was axa0prospective randomized monocentric explorative pilot trial to compare radiation-induced toxicity between IMRT and 3DCRT for patients with spinal metastases. Axa0total of 60xa0patients were randomized between November 2016 and May 2017. In both cohorts, RT was delivered in 10xa0fractions of 3u202fGy each. The primary endpoint was radiation-induced toxicity at 3xa0months.ResultsMedian follow-up was 4.3xa0months. Two patients suffered from gradexa03 acute toxicities in the IMRT arm, along with 1xa0patient in the 3DCRT group. At 12xa0weeks after treatment (t2), 1xa0patient reported gradexa03 toxicity in the IMRT arm vs. 4xa0patients in the 3DCRT group. No gradexa04 or 5 adverse events occurred in either group. In the IMRT arm, the most common side effects by the end of irradiation (t1) were gradexa01–2 xerostomia and nausea in 8xa0patients each (29.6%), and dyspnea in 7xa0patients (25.9%). In the 3DCRT group, the most frequent adverse events (t1) were similar: gradexa01–2 xerostomia (nu202f=u200910, 35.7%), esophagitis (nu202f=u200910, 35.8%), nausea (nu202f=u200910, 35.8%), and dyspnea (nu202f=u20095, 17.9%).ConclusionThis is the first randomized trial to evaluate radiation-induced toxicities after IMRT versus 3DCRT in patients with vertebral metastases. This trial demonstrated an additional improvement for IMRT in terms of acute side effects, although longer follow-up is required to further ascertain other endpoints.ZusammenfassungZielsetzungDie Radiotherapie (RT) stellt einen wichtigen Behandlungsansatz in der palliativen Versorgung von Wirbelkörpermetastasen dar. Das Ausmaß der strahleninduzierten Toxizität bei Patienten mit fortgeschrittener Tumorerkrankung und reduziertem Allgemeinzustand hat erhebliche Auswirkungen auf ihre Lebensqualität. Wir haben die Toxizitätsprofile der intensitätsmodulierten Radiotherapie (IMRT) und der konventionellen dreidimensionalen, konformalen Radiotherapie (3DCRT) hinsichtlich normaler Gewebetoxizitäten und klinisch messbarer Nebenwirkungen miteinander verglichen.MethodenEs handelte sich um eine prospektive, randomisierte, monozentrische explorative Pilotstudie zur Evaluation der strahleninduzierten Toxizität zwischen IMRT und 3DCRT bei Patienten mit Wirbelkörpermetastasen. Insgesamt wurden vom November 2016 bis Mai 2017 60xa0Patienten randomisiert. Die RT wurde in 10xa0Fraktionen von 3u202fGy appliziert. Der primäre Endpunkt war die strahleninduzierte Toxizität nach 3xa0Monaten.ErgebnisseDie mediane Nachbeobachtungszeit betrug 4,3xa0Monate. Im IMRT-Arm litten 2xa0Patienten an akuter Toxizität Gradxa03 und in der 3DCRT-Gruppe 1xa0Patient. Zwölfxa0Wochen (t2) nach der Behandlung berichtete 1xa0Patient über eine Grad-3-Toxizität im IMRT-Arm im Vergleich zu 4xa0Patienten in der 3DCRT-Gruppe. In keiner der beiden Gruppen traten unerwünschte Nebenwirkungen vom Gradxa04 oder 5 auf. Im IMRT-Arm waren die häufigsten Nebenwirkungen am Ende der Bestrahlung (t1) Xerostomie Gradxa01–2 und Nausea bei jeweils 8xa0Patienten (29,6%) sowie Dyspnoe bei 7xa0Patienten (25,9%). In der 3DCRT-Gruppe waren die häufigsten unerwünschten Ereignisse (t1) ähnlich: Xerostomie Gradxa01–2 (nu202f=u200910; 35,7%), Ösophagitis (nu202f=u200910; 35,8%), Nausea (nu202f=u200910; 35,8%) und Dyspnoe (nu202f=u20095; 17,9%).SchlussfolgerungDies ist die erste randomisierte Studie zur Bewertung strahleninduzierter Toxizität nach IMRT im Vergleich zur 3DCRT bei Patienten mit Wirbelkörpermetastasen. Diese Studie zeigte eine zusätzliche Verbesserung bei Anwendung der IMRT in der Palliativmedizin in Bezug auf reduzierte akute Toxizität, obwohl eine längere Nachbeobachtung erforderlich ist, um weitere Endpunkte zu ermitteln.

Sacral insufficiency fractures after high-dose carbon-ion based radiotherapy of sacral chordomas

BackgroundThis study aimed to analyse the frequency and clinical relevance of sacral insufficiency fractures (SIFs) after high-dose carbon-ion based irradiation of sacral chordomas.MethodsA total of 56 patients were included in this retrospective study. Twenty one patients (37%) were treated with definitive radiotherapy (RT), and 35 patients (63%) received postoperative RT using carbon ions, either in combination with photons or as single-modality treatment (median radiation dose 66xa0Gy RBE, range 60–74xa0Gy). Follow-up examinations including MRI of the pelvis were performed at 3-monthly intervals in the first year and consecutively at 6-monthly intervals. Median follow-up was 35.5xa0months (range 2–83).ResultsSIFs were diagnosed in 29 patients (52%) after a median follow-up of 11xa0months (range 1–62xa0months). Most sacral fractures (79%) occurred within 2xa0years after RT. For the overall study population, the fracture-free survival probability amounted to values of 0.68 (95% CI, 0.53–0.79) after 1xa0year, 0.46 (95% CI, 0.31–0.60) after 2xa0years, and 0.31 (95% CI, 0.16–0.47) after 5xa0years. Statistical analysis showed no significant difference regarding the fracture rates between patients who received an operation and postoperative RT and patients treated with definitive RT. About one third of the patients with SIFs (34%; 10 of 29 patients) had associated clinical symptoms, most notably pain. All patients with symptomatic fractures required strong analgesics and often intensive pain management.ConclusionsSacral fractures after high-dose carbon ion-based RT of sacral chordomas were shown to be a considerable radiogenic late effect, affecting about half of the treated patients. However, only one third of these fractures were clinically symptomatic requiring regular medical care and pain therapy.Further hazard factor analysis in the future with larger patient numbers will possibly enable the identification of high-risk patients for developing SIFs with the ultimate goal to prevent symptomatic fractures.

The influence of fractionated radiotherapy on the stability of spinal bone metastases: a retrospective analysis from 1047 cases

BackgroundThe effect of radiotherapy, in particular the application of different multi-fraction schedules in the management of unstable spinal bone metastases (SBM), is incompletely understood. This study aims to compare the radiological response regarding various dose and fractionation schedules of radiotherapy in the palliative treatment of SBM.MethodsWe retrospectively assessed 1047 patients with osteolytic SBM, treated with palliative radiotherapy at our department between 2000 and 2015. Lung cancer (40.2%), breast (16.7%) and renal cancer (15.2%) were the most common solid tumors in this study. Different common multi-fraction regimen (5x4Gy, 10x3Gy, 14u2009×u20092.5Gy and 20x2Gy) were compared with regard to radiological response and recalcification at 3 and 6xa0months after radiotherapy. The Taneichi score was used for classification of osteolytic SBM.ResultsMedian follow up was 6.3xa0months. The median overall survival (OS) in the short-course radiotherapy (SCR) group using less than 10 treatment fractions was 5.5xa0months vs. 9.5xa0months in the long-course radiotherapy (LCR) group using in excess of 10 fractions (log rank pu2009<u2009.0001). Overall survival (OS) in the SCR group after 3 and 6xa0months was 66.8 and 49.1%, respectively vs 80.9 and 61.5%, respectively in the LCR group.17.6% (nxa0=u200954/306) and 31.1% (nxa0=u200989/286) of unstable SBM were classified as stable in the SCR group at 3 and 6xa0months post radiotherapy, respectively (pxa0<u2009.001 for both). In the LCR group, 24.1% (nxa0=u200928/116) and 34.2% (nxa0=u200938/111) of unstable SBM were stabilized after 3 and 6xa0months, respectively (pu2009<u2009.001 for both).ConclusionsOur study shows no significant difference in stabilization achieving recalcification rates between multi-fraction schedules (SCR vs. LCR) in the palliative management of unstable SBM. Both groups with multi-fraction regimen demonstrate a stabilizing effect following 3 and 6xa0months after radiotherapy.