Patients with painful spinal metastases are more likely to have complete resolution of their pain if they have stereotactic body radiotherapy than standard external beam radiotherapy, a study shows.

The finding is at odds with earlier trials, which failed to demonstrate improved pain relief with the more modern technology, suggesting perhaps the dosing regimen used in this phase II/III trial may be beneficial, the authors say.

In the open-label trial, 229 patients from 13 Canadian and five Australian hospitals were randomised to receive either 24Gy stereotactic body radiotherapy in two consecutive daily fractions or conventional external beam radiotherapy at a dose of 20Gy in five consecutive daily fractions.

All had a worst pain score of two or higher on the Brief Pain Inventory (BPI), had solid primary tumours with MRI-confirmed spinal metastases limited to three adjoining vertebrae and had a Spinal Instability in Neoplasia Score (SINS) of 12 or below.