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. 2025 Sep 11:54:100710.
doi: 10.1016/j.jbo.2025.100710. eCollection 2025 Oct.

Stereotactic body radiotherapy for spine and non-spine bone metastases in prostate carcinoma - a multicenter cohort analysis

Franziska Nägler  1   2 , Isabell Seiler  1   2 , Sebastian Schäfer  1   2 , Johannes Meents  3 , Fabian Lohaus  4   5   6 , Arne Grün  7 , Olaf Wittenstein  8 , Kenneth Klischies  8 , Julia Remmele  1   2 , Alexander Rühle  1   2 , Miriam Eckl  3   9 , Oliver Blanck  8 , Judit Boda-Heggemann  3   9 , Frank A Giordano  3   9   10 , Christos Moustakis  1   2 , Nils H Nicolay  1   2 , Lena Kästner  3   9
Affiliations

Stereotactic body radiotherapy for spine and non-spine bone metastases in prostate carcinoma - a multicenter cohort analysis

Franziska Nägler et al. J Bone Oncol. .

Abstract

Background and purpose: Metastases-directed radiotherapy plays an increasing role in oligometastatic prostate cancers (OMPC). Here, we investigated the role of stereotactic body radiotherapy (SBRT) for spine and non-spine bone metastases (BoM) from prostate cancer in a large real-world multicenter cohort.

Material and methods: This multicenter cohort analysis from five tertiary cancer centers included patient data of spine and non-spine BoM irradiated between 2010 and 2024. Overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), SBRT target volumes and doses, toxicity, and the role of additional systemic therapies were evaluated retrospectively.

Results: 231 patients (341 BoM) with median follow-up time of 28.3 months were included. Most common localization were spine (39.3 %), pelvic bone (31.7 %), and ribs (17.9 %). 1- and 5-year PFS for spine BoM were 93.8 % (95 %CI:84.2-97.6 %) and 32.1 % (95 %CI:16.8-44.4 %) and for non-spine BoM 91.7 % (95 %CI:85.1-95.5 %) and 36.6 % (95 %CI:25.8-47.5 %), respectively. 1- and 5-year OS for spine BoM amounted to 94.2 % (95 %CI:85.3-97.8 %) and 69.2 % (95 %CI:50.2-82.2 %) and for non-spine 100 % and 73.3 % (95 %CI:59.1-83.3 %). Older age (p < 0.005) and additional systemic therapies (p = 0.05) were associated with worse OS, older age and larger treatment volumes with worse PFS (p = 0.04). Toxicities were low, with fracture rates of 0.3 % (acute) and 1.2 % (late).

Conclusion: Bone SBRT for OMPC is an effective treatment with low toxicity and particularly low fracture rates for both spine and non-spine BoM with no difference in outcome based on the localization. Prospective trials will help to identify the patients benefitting most from this approach and to establish standardized SBRT concepts incorporating systemic treatments.

Keywords: Bone metastases; Metastasis-directed therapy (MDT); Non-spine metastases; Prostate cancer; Radiotherapy; Spine metastases; Stereotactic radiotherapy.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Alexander Ruehle reports a relationship with Novocure Inc that includes: funding grants, speaking and lecture fees, and travel reimbursement. Alexander Ruehle reports a relationship with Johnson & Johnson that includes: consulting or advisory. Alexander Ruehle reports a relationship with Need Inc. that includes: consulting or advisory. Alexander Ruehle reports a relationship with Merck Healthcare Germany GmbH that includes: consulting or advisory. Alexander Ruehle reports a relationship with AstraZeneca that includes: consulting or advisory. Judit Boda-Heggemann reports a relationship with EBAMed SA that includes: speaking and lecture fees. Judit Boda Heggemann reports a relationship with AstraZeneca that includes: speaking and lecture fees. Judit Boda-Heggemann reports a relationship with BMS that includes: speaking and lecture fees. Lena Kaestner reports a relationship with AstraZeneca that includes: speaking and lecture fees. Miriam Eckl reports a relationship with Siemens Healthineers AG that includes: speaking and lecture fees. Oliver Blanck reports a relationship with DEGRO that includes: board membership. Oliver Blanck reports a relationship with DGMP that includes: board membership. Frank Giordano reports a relationship with TME Pharma that includes: equity or stocks. Frank Giordano reports a relationship with VARIAN, Elekta, Carl Zeiss, Oncomangetx, TME Pharma that includes: consulting or advisory, funding grants, and travel reimbursement. Frank Giordano reports a relationship with Zeiss that includes: speaking and lecture fees. If there are other authors, they 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

None
Graphical abstract
Fig. 1
Fig. 1
Dose distribution for different SBRT concepts. a) Simultaneous Integrated Boost (SIB) concept for BoM in lumbar spine with 5 × 8 Gy for the boost volume and 5 × 4 Gy for the whole vertebra, and b) GTV plus margin concept for BoM in the right ilium with 5 × 8 Gy prescribed to 80 %. Gross Tumor Volume (GTV) is represented by the red contour, and Planning Target Volume (PTV) is represented by the pink contour. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
Oncological outcome parameters. Kaplan-Meier curves for a) overall survival (OS), b) progression-free survival (PFS), c) local recurrence-free survival (LRFS), and d) biochemical recurrence-free survival (BRFS) in prostate cancer for spine and non-spine BoM treated with SBRT.
Fig. 3
Fig. 3
Prognostic variables associated with survival. Kaplan-Meier curves for a) survival probability depending on Gleason score, b) depending on the number on bone metastases (single vs. multiple) in prostate cancer for spine and non-spine BoM treated with SBRT, c) survival probability depending on biologically effective dose (GTVmean BED10) for spine, and d) survival probability for non-spine BoM.
See this image and copyright information in PMC

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