Preop SBRT (27–30Gy/3fx or 18–24Gy/1fx) before fixation shows 6.5% wound-complication rate in impending metastatic fractures

Preoperative SBRT is an ablative, highly conformal RT technique delivered to gross tumor (rather than a large postoperative bed), here given immediately before orthopedic stabilization to potentially improve local control while avoiding postoperative target-volume constraints. In this single-center Phase I nonrandomized trial (NCT05038124), patients with pelvic or long-bone metastases and impending pathologic fracture received SBRT (27–30Gy/3 fx or 18–24Gy/1 fx) then surgery within 1 week; 31 patients were evaluable for the 6-week primary endpoint (38 enrolled; exclusions included inability to receive treatment or death before endpoint). Wound complications occurred in 2/31 (6.5%) at 6 weeks, grade ≥3 treatment-related toxicity in 1/26 (3.8%) by 3 months, and local recurrence in 1/16 (6.3%) at 12 months—signals that look at least comparable on safety to the conventional “surgery then postop RT” paradigm, where guidelines still commonly use 8Gy/1 fx, 20Gy/5 fx, 24Gy/6 fx, or 30Gy/10 fx (and where postoperative RT is recommended for non-spine bone metastases requiring surgery).