Vol 26, No 5 (2021)
Research paper
Published online: 2021-08-12

open access

Page views 6679
Article views/downloads 494
Get Citation

Connect on Social Media

Connect on Social Media

Stereotactic ablative radiation therapy for spinal metastases: experience at a single Brazilian institution

Gustavo Nader Marta1, Fernando F. de Arruda1, Fabiana A. Miranda1, Alice R.N.S. Silva1, Wellington F.P. Neves-Junior1, Anselmo Mancini1, Samir A. Hanna1, Carlos E.C.V. Abreu1, João Luis F. da Silva1, Jose Eduardo V. Nascimento1, Cecília Maria K. Haddad K. Haddad1, Fabio Y. Moraes2, Rafael Gadia1
Rep Pract Oncol Radiother 2021;26(5):756-763.


Background: This study aims to assess the clinical outcomes of patients with spine metastases who underwent stereotactic ablative radiation therapy (SABR) as part of their treatment.

SABR has arisen as a contemporary treatment option for spinal metastasis patients with good prognoses.

Materials and methods: Between November 2010 and September 2018, Spinal SABR was performed in patients with metastatic disease in different settings: radical (SABR only), postoperative (after decompression and/or fixation surgery), and reirradiation. Local control (LC), pain control, overall survival (OS) and toxicities were reported.

Results: Eighty-five patients (corresponding to 96 treatments) with spine metastases were included. The median age was 59 years (range, 23–91). In most SABR (82.3%, n = 79) was performed as the first local spine treatment, while in 12 settings (12.5%), fixation and/or decompression surgery was performed prior to SABR. Two-year overall survival rate was 74.1%, and median survival was 19 months. The LC rate at 2 years was 72.3%. With regard to pain control, among 67 patients presenting with pain before SABR, 83.3% had a complete response, 12.1% had a partial response, and 4.6% had progression. Vertebral compression fractures occurred in 10 patients (11.7%), of which 5 cases occurred in the reirradiation setting. Radiculopathy and myelopathy were not observed. No grade III or IV toxicities were seen.

Conclusion: This is the first study presenting a Brazilian experience with spinal SABR, and the results confirm its feasibility and safety. SABR was shown to produce good local and pain control rates with low rates of adverse events.

Article available in PDF format

View PDF Download PDF file


  1. Duong LM, McCarthy BJ, McLendon RE, et al. Descriptive epidemiology of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumors, United States, 2004-2007. Cancer. 2012; 118(17): 4220–4227.
  2. Lutz S, Balboni T, Jones J, et al. Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol. 2017; 7(1): 4–12.
  3. Silva MF, Marta GN, Lisboa FPC, et al. Hypofractionated radiotherapy for complicated bone metastases in patients with poor performance status: a phase II international trial. Tumori. 2019; 105(2): 181–187.
  4. Rich SE, Chow R, Raman S, et al. Update of the systematic review of palliative radiation therapy fractionation for bone metastases. Radiother Oncol. 2018; 126(3): 547–557.
  5. Klekamp J, Samii H. Surgical results for spinal metastases. Acta Neurochir (Wien). 1998; 140(9): 957–967.
  6. Osborn VW, Lee A, Yamada Y. Stereotactic Body Radiation Therapy for Spinal Malignancies. Technol Cancer Res Treat. 2018; 17: 1533033818802304.
  7. Cox BW, Spratt DE, Lovelock M, et al. International Spine Radiosurgery Consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2012; 83(5): e597–e605.
  8. Redmond KJ, Robertson S, Lo SS, et al. Consensus Contouring Guidelines for Postoperative Stereotactic Body Radiation Therapy for Metastatic Solid Tumor Malignancies to the Spine. Int J Radiat Oncol Biol Phys. 2017; 97(1): 64–74.
  9. Benedict SH, Yenice KM, Followill D, et al. Stereotactic body radiation therapy: the report of AAPM Task Group 101. Med Phys. 2010; 37(8): 4078–4101.
  10. Sahgal A, Weinberg V, Ma L, et al. Probabilities of radiation myelopathy specific to stereotactic body radiation therapy to guide safe practice. Int J Radiat Oncol Biol Phys. 2013; 85(2): 341–347.
  11. Sahgal A, Ma L, Weinberg V, et al. Reirradiation human spinal cord tolerance for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys. 2012; 82(1): 107–116.
  12. National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE). http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm (22 June 2015).
  13. Chow E, Hoskin P, Mitera G, et al. International Bone Metastases Consensus Working Party. Update of the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases. Int J Radiat Oncol Biol Phys. 2012; 82(5): 1730–1737.
  14. Glicksman RM, Tjong MC, Neves-Junior WFP, et al. Stereotactic Ablative Radiotherapy for the Management of Spinal Metastases: A Review. JAMA Oncol. 2020; 6(4): 567–577.
  15. Vellayappan BA, Chao ST, Foote M, et al. The evolution and rise of stereotactic body radiotherapy (SBRT) for spinal metastases. Expert Rev Anticancer Ther. 2018; 18(9): 887–900.
  16. Guckenberger M, Lievens Y, Bouma AB, et al. Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Lancet Oncol. 2020; 21(1): e18–e28.
  17. Palma DA, Olson R, Harrow S, et al. Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial. J Clin Oncol. 2020; 38(25): 2830–2838.
  18. Stereotacticablativeradiotherapyfor oligometastatic non-small cell lung cancer (SARON). Clinicaltrials.gov identifier: NCT02417662. https://clinicaltrials.gov/ct2/show/ NCT02417662 (November 20, 2019).
  19. Conventional care versus radioablation (stereotactic body radiotherapy) for extracranial oligometastases (CORE). Clinicaltrials.gov identifier: NCT02759783. https://clinicaltrials.gov/ct2/show/NCT02759783 (November 20, 2019).
  20. Maintenancechemotherapywithorwithout local consolidative therapy in treating patients with stage IV non–small cell lung cancer. Clinicaltrials.gov identifier: NCT03137771. https://clinicaltrials.gov/ ct2/show/NCT03137771 (November 20, 2019).
  21. Standardofcaretherapywithorwithout stereotactic radiosurgery and/or surgery in treating patients with limited metastatic breast cancer. Clinicaltrials.gov identifier: NCT02364557. https://clinicaltrials.gov/ct2/show/NCT02364557 (November 20, 2019).
  22. Ryu S, Deshmukh S, Timmerman RD, et al. Radiosurgery Compared To External Beam Radiotherapy for Localized Spine Metastasis: Phase III Results of NRG Oncology/RTOG 0631. Int J Radiat Oncol Biol Phys. 2019; 105(1): S2–S3.
  23. Sahgal A, Myrehaug SD, Siva S, et al. CCTG SC.24/TROG 17.06: A Randomized Phase II/III Study Comparing 24Gy in 2 Stereotactic Body Radiotherapy (SBRT) Fractions Versus 20Gy in 5 Conventional Palliative Radiotherapy (CRT) Fractions for Patients with Painful Spinal Metastases. Int J Radiat Oncol Biol Phys. 2020; 108(5): 1397–1398.
  24. Singh R, Lehrer EJ, Dahshan B, et al. Single fraction radiosurgery, fractionated radiosurgery, and conventional radiotherapy for spinal oligometastasis (SAFFRON): A systematic review and meta-analysis. Radiother Oncol. 2020; 146: 76–89.
  25. Myrehaug S, Sahgal A, Hayashi M, et al. Reirradiation spine stereotactic body radiation therapy for spinal metastases: systematic review. J Neurosurg Spine. 2017; 27(4): 428–435.
  26. Faruqi S, Tseng CL, Whyne C, et al. Vertebral Compression Fracture After Spine Stereotactic Body Radiation Therapy: A Review of the Pathophysiology and Risk Factors. Neurosurgery. 2018; 83(3): 314–322.
  27. Bernstein MB, Chang EL, Amini B, et al. Spine Stereotactic Radiosurgery for Patients with Metastatic Thyroid Cancer: Secondary Analysis of Phase I/II Trials. Thyroid. 2016; 26(9): 1269–1275.
  28. Gerszten PC, Burton SA, Ozhasoglu C, et al. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine (Phila Pa 1976). 2007; 32(2): 193–199.
  29. Balagamwala EH, Chao ST, Suh JH. Principles of radiobiology of stereotactic radiosurgery and clinical applications in the central nervous system. Technol Cancer Res Treat. 2012; 11(1): 3–13.

Reports of Practical Oncology and Radiotherapy