Spine Patient Optimal Radiosurgery Treatment for Symptomatic Metastatic Neoplasms (SPORTSMEN)

Objectives: For treatment of spine metastases, stereotactic body radiation therapy (SBRT) has been proven to yield improved local control durability compared with external beam radiation therapy (EBRT) despite requiring more complexity in treatment planning. The time to initiation of treatment is an important consideration in this patient population, yet has rarely been assessed. We present our findings regarding this aspect of care from the Spine Patient Optimal Radiosurgery Treatment for Symptomatic MEtastatic Neoplasms (SPORTSMEN) phase II multicenter randomized controlled trial. Methods: In the SPORTSMEN trial, patients with symptomatic spine metastases are randomized to SBRT (24 Gy in 2 fractions, 19 Gy in 1 fraction) versus EBRT (8 Gy in 1 fraction). The primary trial endpoint is 3-month pain freedom, using the Brief Pain Inventory. The time from patient randomization to treatment initiation was assessed and compared between SBRT and EBRT. Results: Of the first 26 patients treated in the study, 19 received SBRT, and 7 received EBRT. The mean time from randomization to treatment (TRT) for EBRT was 3.7 days (SD±2.36) versus 10.3 days (SD±5.79) for SBRT. This difference in TRT of 6.6 days was statistically significant ( P =0.0079). Conclusion: Level I evidence indicates that compared with EBRT, patients with symptomatic spine metastatic disease receiving SBRT experience an ∼1-week delay in starting treatment. This finding should play a role in informed consent discussions with patients, particularly those who are already symptomatic from their metastatic disease.