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. 2025 Apr 27:53:100966.
doi: 10.1016/j.ctro.2025.100966. eCollection 2025 Jul.

Same-Day Magnetic Resonance-Guided Single-Fraction Stereotactic Body Radiation Therapy for Painful Non-Spine Bone Metastases - A Single-Center Study ("BONE SHOT")

Sebastian M Christ  1 , Eva-Maria Kretschmer  1 , Michael Mayinger  1 , Madalyne Day  1 , Nienke Weitkamp  1 , Amanda Kristina Moreira  1 , Stefanie Ehrbar  1 , Cäcilia S Reiner  2 , Marta Bogowicz  1 , Lotte Wilke  1 , Stephanie Tanadini-Lang  1 , Nicolaus Andratschke  1 , Helena I Garcia Schüler  1 , Matthias Guckenberger  1
Affiliations

Same-Day Magnetic Resonance-Guided Single-Fraction Stereotactic Body Radiation Therapy for Painful Non-Spine Bone Metastases - A Single-Center Study ("BONE SHOT")

Sebastian M Christ et al. Clin Transl Radiat Oncol. .

Abstract

Introduction and background: There is evidence for efficacy of high-dose single-fraction stereotactic body radiotherapy (SF-SBRT) for painful non-spine bone metastases (NSBMs). This study ("BONE SHOT") assessed feasibility of same-day magnetic resonance-guided (MRg) planning and SF-SBRT delivery, recorded toxicity and assessed efficacy for treating metastatic patients with NSBMs.

Materials and methods: Patients with painful (≥3/10 points on a 0-10 numeric rating scale (NRS) for pain) and radiologically confirmed NSBMs from solid organ malignancies were eligible for this prospectively acquired, single-center study. Patients received MRg-SF-SBRT via MR-Linac (ViewRay®) with same-day consultation, consent, planning and treatment. Drop-out rate, procedure times, acute toxicity and pain response were recorded.

Results: Between June 2019 and June 2020, 13 patients with 15 NSBMs were treated per protocol. Mean patient age was 64 (range, 30-87) years; most common primary cancer was gastrointestinal malignancies (38.5 %); most commonly treated site was pelvis (53.3 %). All workflows were completed as planned. Median on-table time for contouring, planning and delivery was 65 (range, 57-112) minutes. Treatments were well tolerated; one patient developed "pain flair"; no grade ≥ 3 toxicities were registered. At one week following SBRT, overall and complete pain response rates were 73.3 % and 20.0 %, respectively, which evolved to 66.7 % and 53.3 % at four weeks after SBRT; median pre-treatment pain score was 6 points, which was reduced by a median of 5 points (P = 0.0028) at four weeks.

Conclusion: The same-day MRg-SF-SBRT workflow for NSBMs was feasible, safe, and preliminary results indicate promising efficacy, warranting future trials investigating this intervention.

Keywords: Bone metastases; MR-Linac; Palliative radiotherapy; SBRT.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Workflow for Same-Day Magnetic Resonance-Guided Single-Fraction Stereotactic Body Radiation Therapy. Abbreviations: CT = Computer tomography; MRI = Magnetic resonance imaging; MRIdian = Hybrid MR-Linac by ViewRay; QA = Quality assurance.
Fig. 2
Fig. 2
Pain response over time. Abbreviations: NRS = Numeric rating scale.Notes: Pain classified on 10-point NRS, with 0 = “no pain” and 10 = “Worst imaginable pain”.
Fig. 3a
Fig. 3a
Example case – Diagnostic, axial CT image for “dummy treatment plan” creation. Abbreviations: CT = Computer tomography.Notes: Based on a diagnostic CT image, the treating radiation oncologist indicated the lesion to treat; treatment planners developed a dummy treatment plan.
Fig. 3b
Fig. 3b
Example case – Axial slice of treatment plan of 12 Gy SF-SBRT of left hip lesion. Abbreviations: CT = Computer tomography; SF = Single fraction; SBRT = Stereotactic body radiation therapy. Notes: At the time of on-table treatment simulation, the CT-based dummy treatment plan was improved before treatment was approved by radiation oncologist and medical physicist.
See this image and copyright information in PMC

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