KEY POINTS
- This systematic review and meta-analysis included 19 randomized controlled or comparative clinical studies of adults with malignant bone tumor pain or risk of skeletal-related events.
- Interventions included single- or multifraction external beam radiotherapy, bone-modifying agents, and radiopharmaceuticals including radium-223, strontium-89, and samarium-153.
- In the radiotherapy subgroup, pain outcomes did not differ significantly across comparisons — standardized mean difference 0.04, 95% confidence interval -0.02 to 0.10.
- Bone-modifying agents showed no overall difference in pain outcomes — standardized mean difference 0.01, 95% confidence interval -0.02 to 0.05; bisphosphonate-only studies showed a small significant effect — standardized mean difference 0.12, 95% confidence interval 0.05 to 0.20, p < 0.05.
- Included trials were generally rated fair to good by Jadad and GRADE assessment, but blinding varied, especially in radiotherapy and open-label bisphosphonate studies.
CLINICAL TAKEAWAY
This review supports the broad evidence base for palliative management of malignant bone pain with radiotherapy, bone-modifying agents, and radiopharmaceuticals. For day-to-day radiation oncology, the clearest practical message is that single-fraction external beam radiotherapy remains comparable to multifraction treatment for pain relief, with retreatment risk still part of the discussion. The evidence is useful as a review-level synthesis, but heterogeneous interventions, pain measures, and follow-up limit how much it can refine individual treatment selection.