Comparative Efficacy of Single-Fraction versus Multi-Fraction Stereotactic Body Radiotherapy for Spinal Metastases: A Meta-Analysis

Abstract

Objective: This study aims to compare the efficacy of stereotactic body radiotherapy (SBRT) in patients with spinal metastases, specifically contrasting single-fraction (SF-SBRT) versus multifraction (MF-SBRT) regimens.

Methods: A comprehensive literature search was conducted across five databases: PubMed, Web of Science, Cochrane Library, Scopus, and Embase. Data extraction and analysis were performed using Engauge Digitizer, Review Manager (RevMan), and STATA software on the selected studies.

Results: Fifteen studies were included in the analysis. In the short term, SF-SBRT was associated with a higher incidence of local failure compared to MF-SBRT; however, it demonstrated a lower rate of post-radiation vertebral compression fractures (VCFs). There were no significant differences in overall survival rates between the two treatment groups. The 1-year and 2-year actuarial local control rates for patients treated with SBRT were 87% and 80%, respectively. The 1-year and 2-year actuarial overall survival rates were 63% and 47%, respectively, for patients treated with SBRT.

Conclusions: Both SF-SBRT and MF-SBRT offer effective treatment options for spinal metastases, each displaying distinct biological and therapeutic profiles. SF-SBRT provides the advantage of convenience and rapid symptom relief, whereas MF-SBRT may offer better long-term control but carries a higher risk of vertebral compression fractures due to cumulative dosing. The choice of regimen should be individualized based on the patient’s clinical situation and preferences. These findings underscore the importance of personalized treatment planning to optimize outcomes for patients with spinal metastases.