Stereotactic body radiotherapy (SBRT) is increasingly used for the treatment of bone metastases (BoM) of oligometastatic prostate cancer. This study aims to provide new information on SBRT for non-spinal BoM of oligometastatic prostate cancer in a large multicenter cohort. Retrospective data from 20 European centers on patients with oligometastatic prostate cancer who received SBRT for BoM between 2010 and 2024 were analyzed to assess patterns of practice, efficacy, safety, and prognosis. A total of 317 patients with 401 BoM were analyzed. The SBRT was delivered in 1–10 fractions, with a median fractional dose of 8 Gy (range 4.0–22.0 Gy) and a corresponding total prescribed dose of 18.0–50.0 Gy. Median follow-up was 25.4 months. Local control at 1 and 3 years was 98.0
This work critically evaluates whether the existing evidence for low-dose radiotherapy (LDRT) in peripheral osteoarthritis can be extrapolated to lumbar facet joint osteoarthritis. Moreover, it aims to determine whether current data justify its routine clinical use or only further investigation in this specific spinal indication. This commentary study synthesizes preclinical data on the anti-inflammatory effects of low-dose irradiation, observational studies reporting symptomatic relief in appendicular osteoarthritis, and higher-level evidence from randomized sham-controlled trials and meta-analyses. It also compares anatomical and biological risks unique to the lumbar spine, particularly vertebral bone marrow exposure and hematologic malignancy potential, and assesses whether modern radiation techniques (e.g., volumetric modulated arc therapy) sufficiently mitigate these risks. Preclinical and observational data suggest anti-inflammatory activity and possible symptomatic improvement with LDRT, but randomized sham-controlled trials and recent meta-analyses fail to confirm significant clinical benefit. The lumbar spine poses additional safety concerns due to its proximity to active bone marrow, and while advanced delivery methods reduce marrow exposure, they do not eliminate it. No spine-specific efficacy or long-term safety data currently exist. Current evidence is insufficient to support routine clinical implementation of LDRT for lumbar facet joint osteoarthritis. The treatment should remain investigational, with a structured research agenda including dosimetric studies, prospective feasibility cohorts, registry surveillance, and long-term sham-controlled trials, which are required to establish both efficacy and safety before any clinical adoption.
BACKGROUND AND OBJECTIVES: Deep brain stimulation (DBS) is a widely used treatment for movement disorders. While bilateral implantation is common, whether to implant electrodes in separate (staged) procedures or in a single (simultaneous) session remains debated. METHODS: In this retrospective matched cohort study, 252 patients who underwent staged bilateral DBS were propensity matched to 252 who underwent simultaneous procedures (n = 504) based on age, sex, and diagnosis. Demographic, clinical, and operative data were extracted from the electronic medical record. RESULTS:Staged patients were older (71.7 +/- 6.4 vs 65.6 +/- 6.9 years, P < .0001) and had lower body mass index (27.4 +/- 5.4 vs 29.1 +/- 6.5 kg/m(2), P = .003). Parkinson's disease predominated in staged cases (54%) and essential tremor in simultaneous (69%) (P < .001); dystonia was rare and similarly distributed (P = .261). DBS targets differed: subthalamic nucleus and globus pallidus internus were more common in staged cases and ventral intermediate nucleus in simultaneous (P < .0001). Sex, race, American Society of Anesthesiologists status classification system scores, and major comorbidities were similar (P > .05). Staged DBS was associated with greater anesthesia utilization, operating room time, and hospital days (all P < .0001). After adjustment for covariates, there were no significant differences in intraoperative complications, postoperative complications, postoperative delirium, 30-day readmissions, medication dose reduction at 1 year, or reoperation within 5 years (odds ratios 0.81-1.44, all P > .5). CONCLUSION: Staged and simultaneous bilateral DBS yield similar clinical outcomes; however, staged procedures require significantly greater resource utilization and subject patients to a more prolonged treatment course.
Patients with primary cutaneous lymphoma may have substantial impairments in health-related quality of life (HRQoL) and may require referral to specialized radiation oncology centers. The current exploratory baseline analysis assessed patient preferences for quality of life (QoL) versus length of life (LoL), travel distance, and baseline HRQoL before radiotherapy. Of 130 screened patients, 82 patients with primary cutaneous lymphoma referred for radiotherapy were enrolled in the prospective S‑MISR registry between September 2019 and August 2024. Their QoL-versus-LoL preferences were assessed using the Quality–Quantity Questionnaire. Baseline HRQoL was evaluated using Skindex-29 and EORTC QLQ-C30. Travel distance to the treating radiation oncology department was analyzed overall and by lymphoma subtype. Median age was 63 years (range 34–92), and 59 patients (72
