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Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis

Guckenberger, M and Mantel, F and Gerszten, PC and Flickinger, JC and Sahgal, A and Létourneau, D and Grills, IS and Jawad, M and Fahim, DK and Shin, JH and Winey, B and Sheehan, J and Kersh, R (2014) Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis. Radiation oncology (London, England), 9. 226 - ?.

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Abstract

PURPOSE: To evaluate patient selection criteria, methodology, safety and clinical outcomes of stereotactic body radiotherapy (SBRT) for treatment of vertebral metastases.MATERIALS AND METHODS: Eight centers from the United States (n=5), Canada (n=2) and Germany (n=1) participated in the retrospective study and analyzed 301 patients with 387 vertebral metastases. No patient had been exposed to prior radiation at the treatment site. All patients were treated with linac-based SBRT using cone-beam CT image-guidance and online correction of set-up errors in six degrees of freedom.RESULTS: 387 spinal metastases were treated and the median follow-up was 11.8 months. The median number of consecutive vertebrae treated in a single volume was one (range, 1-6), and the median total dose was 24 Gy (range 8-60 Gy) in 3 fractions (range 1-20). The median EQD210 was 38 Gy (range 12-81 Gy). Median overall survival (OS) was 19.5 months and local tumor control (LC) at two years was 83.9%. On multivariate analysis for OS, male sex (p<0.001; HR=0.44), performance status <90 (p<0.001; HR=0.46), presence of visceral metastases (p=0.007; HR=0.50), uncontrolled systemic disease (p=0.007; HR=0.45), >1 vertebra treated with SBRT (p=0.04; HR=0.62) were correlated with worse outcomes. For LC, an interval between primary diagnosis of cancer and SBRT of ≤ 30 months (p=0.01; HR=0.27) and histology of primary disease (NSCLC, renal cell cancer, melanoma, other) (p=0.01; HR=0.21) were correlated with worse LC. Vertebral compression fractures progressed and developed de novo in 4.1% and 3.6%, respectively. Other adverse events were rare and no radiation induced myelopathy reported.CONCLUSIONS: This multi-institutional cohort study reports high rates of efficacy with spine SBRT. At this time the optimal fractionation within high dose practice is unknown.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Guckenberger, M
Mantel, F
Gerszten, PC
Flickinger, JCjflickin@pitt.eduJFLICKIN
Sahgal, A
Létourneau, D
Grills, IS
Jawad, M
Fahim, DK
Shin, JH
Winey, B
Sheehan, J
Kersh, R
Date: 16 October 2014
Date Type: Publication
Journal or Publication Title: Radiation oncology (London, England)
Volume: 9
Page Range: 226 - ?
DOI or Unique Handle: 10.1186/s13014-014-0226-2
Schools and Programs: School of Medicine > Neurological Surgery
School of Medicine > Radiation Oncology
Refereed: Yes
Date Deposited: 21 Dec 2016 20:45
Last Modified: 02 Feb 2019 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/29481

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