Vol 27, No 1 (2022)
Review paper
Published online: 2022-01-24

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Stereotactic radiotherapy for bone oligometastases

Caterina Colosimo1, Francesco Pasqualetti2, Cynthia Aristei3, Simona Borghesi4, Letizia Forte5, Marcello Mignogna1, Donatella Badii5, Manrico Bosio5, Fabiola Paiar2, Sara Nanni4, Silvia Bertocci4, Luciana Lastrucci5, Silvana Parisi6, Gianluca Ingrosso3
Rep Pract Oncol Radiother 2022;27(1):40-45.

Abstract

About 60–90% of cancer patients are estimated to develop bone metastases, particularly in the spine.

Bone scintigraphy, computed tomography (CT) and magnetic resonance imaging (MRI) are currently used to assess metastatic bone disease; positron emission tomography/computed tomography (PET/CT) has become more widespread in clinical practice because of its high sensitivity and specificity with about 95% diagnostic accuracy. The most common and well-known radiotracer is 18F-fluorodeoxyglucose (18FDG); several other PET-radiotracers are currently under investigation for different solid tumors, such as 11C or 18FDG-choline and prostate specific membrane antigen (PSMA)-PET/CT for prostate cancer. In treatment planning, standard and investigational imaging modalities should be registered with the planning CT so as to best define the bone target volume. For target volume delineation of spine metastases, the International Spine Radiosurgery Consortium (ISRC) of North American experts provided consensus guidelines. Single fraction stereotactic radiotherapy (SRT) doses ranged from 12 to 24 Gy; fractionated SRT administered 21–27 Gy in 3 fractions or 20–35 Gy in 5 fractions. After spine SRT, less than 5% of patients experienced grade ≥ 3 acute toxicity. Late toxicity included the extremely rare radiation-induced myelopathy and a 14% risk of de novo vertebral compression fractures.

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