Stereotactic Body Radiation Therapy for Non-Spine Bone Metastases: A Case-Based Radiosurgery Society Review
- Author(s)
- Liu, Y; Goldrich, N; Redmond, KJ; Gabriel, J; Zhou, N; Swensen, S; Skalina, KA; Fekrmandi, F; Vellayappan, B; Guckenberger, M; Foote, M; Connell, PP; Hsu, CC; Vuong, W; Gillespie, EF; Tykodi, SS; Nguyen, TK; Mayerson, JL; Nguyen, QN; de Moraes, FY; Siva, S; Palmer, JD; Kim, M; Yang, JT; Sahgal, A; Lo, SS;
- Journal Title
- Practical Radiation Oncology
- Publication Type
- Online publication before print
- Abstract
- PURPOSE: Growing evidence supports stereotactic body radiation therapy (SBRT) over conventional radiation therapy for spine bone metastases, with an expanding role in non-spine bone metastases (NSBM). Our case-based review aims to inform radiation oncologists in the appropriate utilization of SBRT for representative cases of NSBM. METHODS AND MATERIALS: Three cases were selected for discussion: (1) rib, (2) skull base, and (3) femur. Relevant literature was reviewed, and areas for future investigation were discussed. RESULTS: SBRT can be effectively delivered in NSBM with appropriate patient selection, target volume delineation, prescription dose, organs at risk dose constraints, and treatment planning. CONCLUSIONS: The Radiosurgery Society's case-based review offers guidance on the appropriate use of SBRT in NSBM with discussions and consensus recommendations from experts. SBRT can be considered for an oligometastatic patient with favorable prognosis in whom the goal is durable local control and/or symptom relief. It can be considered for radioresistant histologies and improved OAR sparing. Available MRI or PET/CT should be fused to improve target volume delineation. A CTV margin, generally of 5 mm, should be considered to cover microscopic disease. As bones are easily visualized on daily images acquired for accurate and precise set-up of patients, a PTV margin should be kept less than or equal to 3 mm. While SBRT can be delivered in 1 fraction, fractionated SBRT may be preferred to meet dose constraints when the CTV is adjacent to the OARs. NSBM of long bones that are weight bearing, lytic, or have a high MIRELS score should be evaluated by an orthopedic surgeon.
- Department(s)
- Radiation Oncology
- Publisher's Version
- https://doi.org/10.1016/j.prro.2026.04.004
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2026-05-19 02:35:06
Last Modified: 2026-05-19 02:35:24