Planning computed tomography (CT) simulation was performed with a slice thickness of 2 mm. This study was approved by the ethics review board (approval number 2132) of our institution, and written informed consent was obtained from all patients. However, for patients who were medically contraindicated for surgery, we conducted SBRT without surgery. We first considered (prophylactic) surgical fixation for patients with surgical indications owing to imminent or pathological fractures. Bone SBRT was not indicated for the following patients who (i) had radiation-sensitive primary tumors, including malignant lymphomas, myelomas or germ cell tumors or (ii) had difficulty lying supine for 30 minutes. The humerus, radius, ulna, femur, fibula and tibia were defined as the ‘long bone.’ Bone SBRT was administered to patients with a previously irradiated painful lesion or patients with oligometastatic osseous lesion. The database of a single Japanese institution was retrospectively reviewed to identify patients treated with SBRT for long bone metastases between July 2016 and November 2020. Materials and methods Patients and data acquisition Therefore, we aimed to retrospectively analyze clinical outcomes focused on fracture risk after SBRT in patients with long bone metastases. However, few studies evaluating SBRT for long bone metastases have been reported. Moreover, long bones should be in a different category among non-spine bone SBRT since the fractures of long bones have a major impact on patients’ symptomatic burden, daily activities and quality of life. A systematic review based on the retrospective data of non-spine bone metastases showed that SBRT resulted in a high local control rate of >85% with very few severe adverse effects (AEs) ( 2). Therefore, spinal metastases and non-spine bone metastases are recognized as having different pathophysiologies ( 6). The standard therapy and irradiation method in SBRT for bone metastases differs depending on whether the spinal cord is adjacent to the target. A recent randomized phase II trial suggested that there were survival benefits of SBRT for oligometastatic disease ( 4) however, SBRT has shown a higher vertebral compression fracture occurrence rate than conventional radiotherapy for spinal metastases ( 5). The need for bone SBRT has increased because innovations in systemic therapy have extended the life expectancy of patients with metastatic disease ( 3). Numerous clinical studies suggest that SBRT for bone metastases has resulted in long-term tumor and pain control ( 1, 2). Bone fracture, long bone metastases, non-spine bone metastases, oligometastasis, stereotactic body radiotherapy IntroductionĪs a new treatment modality for bone metastasis, stereotactic body radiotherapy (SBRT) can deliver high-dose radiation to the target volume and spare adjacent at-risk organs.
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