Vol 26, No 6 (2021)
Research paper
Published online: 2021-08-17
Local control of 1–5 fraction radiotherapy regimens for spinal metastases: an analysis of the impacts of biologically effective dose and primary histology
Rep Pract Oncol Radiother 2021;26(6):883-891.
Abstract
Background: This analysis evaluates the impacts of biologically effective dose (BED) and histology on local control (LC) of spinal metastases treated with highly conformal radiotherapy to moderately-escalated doses.
Materials and methods: Patients were treated at two institutions from 2010–2020. Treatments with less than 5 Gy per fraction or 8 Gy in 1 fraction were excluded. The dataset was divided into three RPA classes predictive of survival (1). The primary endpoint was LC.
Results: 223 patients with 248 treatments met inclusion criteria. Patients had a median Karnofsky Performance Status (KPS) of 80, and common histologies included breast (29.4%), non-small cell lung cancer (15.7%), and prostate (13.3%). A median 24 Gy was delivered in 3 fractions (BED: 38.4 Gy) to a median planning target volume (PTV) of 37.3 cc. 2-year LC was 75.7%, and 2-year OS was 42.1%. Increased BED was predictive of improved LC for primary prostate cancer (HR = 0.85, 95% CI: 0.74–0.99). Patients with favorable survival (RPA class 1) had improved LC with BED ≥ 40 Gy (p = 0.05), unlike the intermediate and poor survival groups. No grade 3–5 toxicities were reported.
Conclusions: Moderately-escalated treatments were efficacious and well-tolerated. BED ≥ 40 Gy may improve LC, particularly for prostate cancer and patients with favorable survival.
Keywords: stereotactic body radiation therapy (SBRT)palliative caremetastasisspinedose-escalation
References
- Chao ST, Koyfman SA, Woody N, et al. Recursive partitioning analysis index is predictive for overall survival in patients undergoing spine stereotactic body radiation therapy for spinal metastases. Int J Radiat Oncol Biol Phys. 2012; 82(5): 1738–1743.
- Chang JH, Shin JH, Yamada YJ, et al. Stereotactic Body Radiotherapy for Spinal Metastases: What are the Risks and How Do We Minimize Them? Spine (Phila Pa 1976). 2016; 41 Suppl 20: S238–S245.
- Sahgal A, Chang JH, Ma L, et al. Spinal Cord Dose Tolerance to Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys. 2021; 110(1): 124–136.
- 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.
- Wong CS, Fehlings MG, Sahgal A. Pathobiology of radiation myelopathy and strategies to mitigate injury. Spinal Cord. 2015; 53(8): 574–580.
- Redmond KJ, Sciubba D, Khan M, et al. A Phase 2 Study of Post-Operative Stereotactic Body Radiation Therapy (SBRT) for Solid Tumor Spine Metastases. Int J Radiat Oncol Biol Phys. 2020; 106(2): 261–268.
- Sahgal A, Myrehaug S, Dennis K, et al. A randomized phase II/III study comparing stereotactic body radiotherapy (SBRT) versus conventional palliative radiotherapy (CRT) for patients with spinal metastases (NCT02512965). J Clin Oncol. 2017; 35(15_suppl): TPS10129–TPS10129.
- Tibdewal A, Agarwal JP, Srinivasan S, et al. Swiss Group for Clinical Cancer Research (SAKK). Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study. Lancet Oncol. 2016; 17(12): 1672–1682.
- Iyengar P, Kavanagh BD, Wardak Z, et al. Phase II trial of stereotactic body radiation therapy combined with erlotinib for patients with limited but progressive metastatic non-small-cell lung cancer. J Clin Oncol. 2014; 32(34): 3824–3830.
- Palma DA, Olson R, Harrow S, et al. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet. 2019; 393(10185): 2051–2058.
- Ryu S, Pugh SL, Gerszten PC, et al. RTOG 0631 phase 2/3 study of image guided stereotactic radiosurgery for localized (1-3) spine metastases: phase 2 results. Pract Radiat Oncol. 2014; 4(2): 76–81.
- Tseng CL, Soliman H, Myrehaug S, et al. Imaging-Based Outcomes for 24 Gy in 2 Daily Fractions for Patients with de Novo Spinal Metastases Treated With Spine Stereotactic Body Radiation Therapy (SBRT). Int J Radiat Oncol Biol Phys. 2018; 102(3): 499–507.
- Hashmi A, Guckenberger M, Kersh R, et al. Re-irradiation stereotactic body radiotherapy for spinal metastases: a multi-institutional outcome analysis. J Neurosurg Spine. 2016; 25(5): 646–653.
- 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.
- Thibault I, Campbell M, Tseng CL, et al. Salvage Stereotactic Body Radiotherapy (SBRT) Following In-Field Failure of Initial SBRT for Spinal Metastases. Int J Radiat Oncol Biol Phys. 2015; 93(2): 353–360.
- Kinhikar RA, Ghadi YG, Sahoo P, et al. Dosimetric comparison of three-dimensional conformal radiotherapy, intensity modulated radiotherapy, and helical tomotherapy for lung stereotactic body radiotherapy. J Med Phys. 2015; 40(4): 190–197.
- Lee DS, Kwak YK, Jeong SMi, et al. High-dose radiotherapy using helical tomotherapy for vertebral metastasis: early clinical outcomes and cord dose specification. Jpn J Clin Oncol. 2013; 43(6): 646–653.
- Sprave T, Verma V, Förster R, et al. Randomized phase II trial evaluating pain response in patients with spinal metastases following stereotactic body radiotherapy versus three-dimensional conformal radiotherapy. Radiother Oncol. 2018; 128(2): 274–282.
- 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.
- Thibault I, Chang EL, Sheehan J, et al. Response assessment after stereotactic body radiotherapy for spinal metastasis: a report from the SPIne response assessment in Neuro-Oncology (SPINO) group. Lancet Oncol. 2015; 16(16): e595–e603.
- 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.
- Nelson JW, Yoo DS, Sampson JH, et al. Stereotactic body radiotherapy for lesions of the spine and paraspinal regions. Int J Radiat Oncol Biol Phys. 2009; 73(5): 1369–1375.
- Jensen G, Tang C, Hess KR, et al. Internal validation of the prognostic index for spine metastasis (PRISM) for stratifying survival in patients treated with spinal stereotactic radiosurgery. J Radiosurg SBRT. 2017; 5(1): 25–34.
- Tseng CL, Eppinga W, Charest-Morin R, et al. Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution. Global Spine J. 2017; 7(2): 179–197.
- Habl G, Straube C, Schiller K, et al. Oligometastases from prostate cancer: local treatment with stereotactic body radiotherapy (SBRT). BMC Cancer. 2017; 17(1): 361.
- Jardel P, Kammerer E, Villeneuve H, et al. Stereotactic radiation therapy for breast cancer in the elderly. Translat Cancer Res. 2020; 9(S1): S86–S96.
- Palacios-Eito A, Béjar-Luque A, Rodríguez-Liñán M, et al. Oligometastases in prostate cancer: Ablative treatment. World J Clin Oncol. 2019; 10(2): 38–51.
- Sage EK, Vogel MME, Dewes S, et al. [Stereotactic body radiotherapy (SBRT) for the treatment of bone metastases in oligometastasised prostate cancer]. Aktuelle Urol. 2020; 51(3): 265–270.
- Zeng KL, Tseng CL, Soliman H, et al. Stereotactic Body Radiotherapy (SBRT) for Oligometastatic Spine Metastases: An Overview. Front Oncol. 2019; 9: 337.
- Dunne EM, Fraser IM, Liu M. Stereotactic body radiation therapy for lung, spine and oligometastatic disease: current evidence and future directions. Ann Transl Med. 2018; 6(14): 283.
- Phillips R, Shi WY, Deek M, et al. Outcomes of Observation vs Stereotactic Ablative Radiation for Oligometastatic Prostate Cancer: The ORIOLE Phase 2 Randomized Clinical Trial. JAMA Oncol. 2020; 6(5): 650–659.
- Mehta N, Zavitsanos PJ, Moldovan K, et al. Local failure and vertebral body fracture risk using multifraction stereotactic body radiation therapy for spine metastases. Adv Radiat Oncol. 2018; 3(3): 245–251.
- Guckenberger M, Mantel F, Gerszten PC, et al. Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis. Radiat Oncol. 2014; 9: 226.