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Van den Brande R, Van den Kieboom M, Peeters M, Billiet C, Van de Kelft E. Remineralization of lytic spinal metastases after radiation therapy - A retrospective cohort study comparing conventional external beam radiation therapy with stereotactic ablative body radiation. Clin Transl Radiat Oncol 2024; 48:100805. [PMID: 38988807 PMCID: PMC11231653 DOI: 10.1016/j.ctro.2024.100805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Osteolytic spinal metastases (SM) have a higher risk of fracture. In this study we aim to confirm the remineralization of lytic SM after radiation therapy. Secondary the influence of SBRT compared to cEBRT and tumor type will be analyzed. Methods A retrospective cohort study was performed. Results 87 patients, 100 SM were included. 29 received SBRT, 71 cEBRT. Most common primary tumors were breast (35 %), lung (26 %) and renal (11 %). Both cEBRT and SBRT resulted in a significant increase of bone mineral density (BMD) (83.76 HU ± 5.72 → 241.41 HU ± 22.58 (p < 0.001) and 82.45 ± 9.13 → 179.38 ± 47.83p = 0.026). There was a significant increase in absolute difference of BMD between the SM and reference vertebrae (p < 0.001). There was no significant difference between SBRT and cEBRT. There was no increase of BMD in renal lytic SM after radiation therapy (pre-treatment: 85.96 HU ± 19.07; 3 m 92.00 HU ± 21.86 (p = 0.882); 6 m 92.06 HU ± 23.94 (p = 0.902); 9 m 70.44 HU ± 7.45 (p = 0.213); 12 m 98.08 HU ± 11.24 (p = 0.740)). In all other primary tumors, a significant increase of BMD after radiation therapy was demonstrated (p < 0,05). Conclusion We conclude that the BMD of lytic SM increases significantly after radiation therapy. Lytic SM of primary renal tumors are the exception; there is no significant remineralization of renal lytic SM after radiation therapy. There is no benefit of SBRT over cEBRT in this remineralization. These findings should be taken into account when deciding on surgery in the potentially unstable group defined by the spinal instability neoplastic score.
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Affiliation(s)
- Ruben Van den Brande
- University of Antwerp, Belgium
- Department of Neurosurgery, AZ KLINA, Brasschaat, Belgium
| | | | - Marc Peeters
- University of Antwerp, Belgium
- Department of Oncology, Antwerp University Hospital, Belgium
| | - Charlotte Billiet
- University of Antwerp, Belgium
- Department of Radiation Oncology, Iridium Netwerk, University of Antwerp, Belgium
| | - Erik Van de Kelft
- University of Antwerp, Belgium
- Department of Neurosurgery, Vitaz, Sint-Niklaas, Belgium
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Wang S, Chen Z, Wang K, Li H, Qu H, Mou H, Lin N, Ye Z. Effect of radiotherapy on local control and overall survival in spinal metastasis of non-small-cell lung cancer after surgery and systemic therapy. Bone Jt Open 2024; 5:350-360. [PMID: 38649150 PMCID: PMC11035006 DOI: 10.1302/2633-1462.54.bjo-2024-0037.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Aims Radiotherapy is a well-known local treatment for spinal metastases. However, in the presence of postoperative systemic therapy, the efficacy of radiotherapy on local control (LC) and overall survival (OS) in patients with spinal metastases remains unknown. This study aimed to evaluate the clinical outcomes of post-surgical radiotherapy for spinal metastatic non-small-cell lung cancer (NSCLC) patients, and to identify factors correlated with LC and OS. Methods A retrospective, single-centre review was conducted of patients with spinal metastases from NSCLC who underwent surgery followed by systemic therapy at our institution from January 2018 to September 2022. Kaplan-Meier analysis and log-rank tests were used to compare the LC and OS between groups. Associated factors for LC and OS were assessed using Cox proportional hazards regression analysis. Results Overall, 123 patients with 127 spinal metastases from NSCLC who underwent decompression surgery followed by postoperative systemic therapy were included. A total of 43 lesions were treated with stereotactic body radiotherapy (SBRT) after surgery and 84 lesions were not. Survival rate at one, two, and three years was 83.4%, 58.9%, and 48.2%, respectively, and LC rate was 87.8%, 78.8%, and 78.8%, respectively. Histological type was the only significant associated factor for both LC (p = 0.007) and OS (p < 0.001). Treatment with targeted therapy was significantly associated with longer survival (p = 0.039). The risk factors associated with worse survival were abnormal laboratory data (p = 0.021), lesions located in the thoracic spine (p = 0.047), and lumbar spine (p = 0.044). This study also revealed that postoperative radiotherapy had little effect in improving OS or LC. Conclusion Tumour histological type was significantly associated with the prognosis in spinal NSCLC metastasis patients. In the presence of post-surgical systemic therapy, radiotherapy appeared to be less effective in improving LC, OS, or quality of life in spinal NSCLC metastasis patients.
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Affiliation(s)
- Shengdong Wang
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Zehao Chen
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Keyi Wang
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Hengyuan Li
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Hao Qu
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Haochen Mou
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Nong Lin
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
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Guckenberger M, Andratschke N, Belka C, Bellut D, Cuccia F, Dahele M, Guninski RS, Josipovic M, Mancosu P, Minniti G, Niyazi M, Ricardi U, Munck Af Rosenschold P, Sahgal A, Tsang Y, Verbakel W, Alongi F. ESTRO clinical practice guideline: Stereotactic body radiotherapy for spine metastases. Radiother Oncol 2024; 190:109966. [PMID: 37925107 DOI: 10.1016/j.radonc.2023.109966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND AND PURPOSE Recent progress in diagnostics and treatment of metastatic cancer patients have improved survival substantially. These developments also affect local therapies, with treatment aims shifting from short-term palliation to long-term symptom or disease control. There is consequently a need to better define the value of stereotactic body radiotherapy (SBRT) for the treatment of spinal metastases. METHODS This ESTRO clinical practice guideline is based on a systematic literature review conducted according to PRISMA standards, which formed the basis for answering four key questions about the indication and practice of SBRT for spine metastases. RESULTS The analysis of the key questions based on current evidence yielded 22 recommendations and 5 statements with varying levels of endorsement, all achieving a consensus among experts of at least 75%. In the majority, the level of evidence supporting the recommendations and statements was moderate or expert opinion, only, indicating that spine SBRT is still an evolving field of clinical research. Recommendations were established concerning the selection of appropriate patients with painful spine metastases and oligometastatic disease. Recommendations about the practice of spinal SBRT covered technical planning aspects including dose and fractionation, patient positioning, immobilization and image-guided SBRT delivery. Finally, recommendations were developed regarding quality assurance protocols, including description of potential SBRT-related toxicity and risk mitigation strategies. CONCLUSIONS This ESTRO clinical practice guideline provides evidence-based recommendations and statements regarding the selection of patients with spinal metastases for SBRT and its safe implementation and practice. Enrollment of patients into well-designed prospective clinical trials addressing clinically relevant questions is considered important.
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Affiliation(s)
- M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - N Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - C Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - D Bellut
- University Hospital Zurich, University of Zurich, Department of Neurosurgery, Zurich, Switzerland
| | - F Cuccia
- ARNAS Civico Hospital, Radiation Oncology Unit, Palermo, Italy
| | - M Dahele
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiation Oncology and Cancer Center Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
| | - R S Guninski
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Josipovic
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9 2100, Copenhagen, Denmark; Department of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B 2200, Copenhagen, Denmark
| | - P Mancosu
- IRCCS Humanitas Research Hospital, Medical Physics Unit, Radiation Oncology department, via Manzoni 56 I-20089, Rozzano, Milan, Italy
| | - G Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - M Niyazi
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - U Ricardi
- University of Turin, Department of Oncology, Turin, Italy
| | | | - A Sahgal
- Odette Cancer Center of the Sunnybrook Health Sciences Center, Department of Radiation Oncology, Toronto, Canada
| | - Y Tsang
- Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada
| | - Wfar Verbakel
- Amsterdam University Medical Center, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - F Alongi
- Advanced Radiation Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar-Verona, Italy; University of Brescia, Italy
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Iramina H, Nakamura M, Nakamura K, Fujimoto T, Mizowaki T. Quantification of six-degree-of-freedom motion during beam delivery in spine stereotactic body radiotherapy using intra-irradiation cone-beam computed tomography imaging technique. Phys Med 2023; 110:102605. [PMID: 37167776 DOI: 10.1016/j.ejmp.2023.102605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/22/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE Quantifying intra-fractional six-degree-of-freedom (6DoF) residual errors or motion from approved patient setups is necessary for accurate beam delivery in spine stereotactic body radiotherapy. However, previously reported errors were not acquired during beam delivery. Therefore, we aimed to quantify the 6DoF residual errors and motions during arc beam delivery using a concurrent cone-beam computed tomography (CBCT) imaging technique, intra-irradiation CBCT. METHODS Consecutive 15 patients, 19 plans for various treatment sites, and 199 CBCT images were analyzed. Pre-irradiation CBCT was performed to verify shifts from the initial patient setup using the ExacTrac system. During beam delivery by two or three co-planar full-arc rotations, CBCT imaging was performed concurrently. Subsequently, an intra-irradiation CBCT image was reconstructed. Pre- and intra-irradiation CBCT images were rigidly registered to a planning CT image based on the bone to quantify 6DoF residual errors. RESULTS 6DoF residual errors quantified using pre- and intra-irradiation CBCTs were within 2.0 mm/2.0°, except for one measurement. The mean elapsed time (mean ± standard deviation [min:sec]) after pre-irradiation CBCT to the end of the last arc beam delivery was 6:08 ± 1:25 and 7:54 ± 2:14 for the 2- and 3-arc plans, respectively. Root mean squares of residual errors for several directions showed significant differences; however, they were within 1.0 mm/1.0°. Time-dependent analysis revealed that the residual errors tended to increase with elapsed time. CONCLUSION The errors represent the optimal intra-fractional error compared with those acquired using the pre-, inter-beam, and post-6DoF image guidance and can be acquired within a standard treatment timeslot.
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Affiliation(s)
- Hiraku Iramina
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Mitsuhiro Nakamura
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Kiyonao Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takahiro Fujimoto
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
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Du S, Hu P, Zhuang H, Yang S, Wei F. Treatment of spinal rhabdomyosarcoma in adults: A case report and literature review of current evidence. Oncol Lett 2023; 25:99. [PMID: 36817053 PMCID: PMC9931996 DOI: 10.3892/ol.2023.13685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/05/2023] [Indexed: 01/31/2023] Open
Abstract
Spinal rhabdomyosarcoma (RMS) is a rare yet highly malignant tumor in adults. Literature on this entity is lacking and no mature treatment guideline is currently available. The treatment arsenals include surgery, radiotherapy and chemotherapy, being used singly or jointly. However, the prognosis is dismal, with a mean overall survival period of 10 months. Thus, any case of this disease with encouraging outcomes shall be shared. A case of a middle-aged female patient with spinal RMS was presented in the current report. The patient suffered from back pain but was neurologically intact. The patient underwent a total en-bloc spondylectomy of the T11-L2 vertebrae and spinal reconstruction with 3D-printed prosthetic vertebrae. Afterwards, the patient received a rigid schedule of stereotactic body radiotherapy (SBRT) and chemotherapy. To date, the patient has survived for 40 months, with the preservation of neurological function and sustained mitigation of local pain after the operation. The patient suffered subcutaneous colonization of tumor cells and pulmonary metastasis 10 months postoperatively, but obtained a long locoregional control of 19 months. In conclusion, total en-bloc lesion resection is indicated for the treatment of isolated, primary spinal RMS in adults. Some authors reported that the usage of new surgical tools and instruments has facilitated surgery, which was previously invasive and technically challenging. Advanced radiotherapy techniques, such as SBRT, which were proven effective for local lesion control, should be implemented early after the operation. Chemotherapy remains the mainstay of treatment, but further research and evidence for the efficacy of regimens specifically for adults are required.
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Affiliation(s)
- Suiyong Du
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, P.R. China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing 100191, P.R. China,Department of Spine Surgery, 521 Hospital of Norinco Group, Xi'an, Shanxi 710065, P.R. China
| | - Panpan Hu
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, P.R. China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Hongqing Zhuang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Shaomin Yang
- Department of Pathology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Feng Wei
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, P.R. China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing 100191, P.R. China,Correspondence to: Dr Feng Wei, Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing 100191, P.R. China, E-mail:
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Deodato F, Pezzulla D, Cilla S, Ferro M, Giannini R, Romano C, Boccardi M, Buwenge M, Valentini V, Morganti AG, Macchia G. Volumetric Intensity-Modulated Arc Stereotactic Radiosurgery Boost in Oligometastatic Patients with Spine Metastases: a Dose-escalation Study. Clin Oncol (R Coll Radiol) 2023; 35:e30-e39. [PMID: 36207236 DOI: 10.1016/j.clon.2022.09.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/12/2022] [Accepted: 09/13/2022] [Indexed: 01/06/2023]
Abstract
AIMS To report the final results of a dose-escalation study of volumetric intensity-modulated arc stereotactic radiosurgery (VMAT-SRS) boost after three-dimensional conformal radiation therapy in patients with spine metastases. MATERIALS AND METHODS Oligometastatic cancer patients bearing up to five synchronous metastases (visceral or bone, including vertebral ones) and candidates for surgery or radiosurgery were considered for inclusion. 25 Gy was delivered in 10 daily fractions (2 weeks) to the metastatic lesion, affected vertebrae and adjacent ones (one cranial and one caudal vertebra). Sequentially, the dose to spinal metastases was progressively increased (8 Gy, 10 Gy, 12 Gy) in the patient cohorts. Dose-limiting toxicities were defined as any treatment-related non-hematologic acute adverse effects rated as grade ≥3 or any acute haematological toxicity rated as ≥ 4 by the Radiation Therapy Oncology Group scale. RESULTS Fifty-two lesions accounting for 40 consecutive patients (male/female: 29/11; median age: 71 years; range 40-85) were treated from April 2011 to September 2020. Most patients had a primary prostate (65.0%) or breast cancer (22.5%). Thirty-two patients received 8 Gy VMAT-SRS boost (total BED α/β10: 45.6 Gy), 14 patients received 10 Gy (total BED α/β10: 51.2 Gy) and six patients received 12 Gy (total BED α/β10: 57.6 Gy). The median follow-up time was over 70 months (range 2-240 months). No acute toxicities > grade 2 and no late toxicities > grade 1 were recorded. The overall response rate based on computed tomography/positron emission tomography-computed tomography/magnetic resonance was 78.8%. The 24-month actuarial local control, distant metastases-free survival and overall survival rates were 88.5%, 27.1% and 90.3%, respectively. CONCLUSION A 12 Gy spine metastasis SRS boost following 25 Gy to the affected and adjacent vertebrae was feasible with an excellent local control rate and toxicity profile.
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Affiliation(s)
- F Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy; Radiology Institute, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - D Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - S Cilla
- Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - M Ferro
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - R Giannini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Rome, Italy.
| | - C Romano
- Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - M Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - M Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna, Bologna, Italy.
| | - V Valentini
- Radiology Institute, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Rome, Italy.
| | - A G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna, Bologna, Italy.
| | - G Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
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Hadj Henni A, Gensanne D, Bulot G, Roge M, Mallet R, Colard E, Daras M, Hanzen C, Thureau S. ExacTrac X-Ray 6D Imaging During Stereotactic Body Radiation Therapy of Spinal and Nonspinal Metastases. Technol Cancer Res Treat 2023; 22:15330338231210786. [PMID: 37904530 PMCID: PMC10619343 DOI: 10.1177/15330338231210786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/23/2023] [Accepted: 10/12/2023] [Indexed: 11/01/2023] Open
Abstract
The objective was to investigate the possibility of using ExacTrac X-ray (ETX) for 6D image guidance in stereotactic body radiation therapy (SBRT) of bone metastasis and to propose a patient management protocol. The analyses were first obtained from measurements on a pelvic phantom and on 19 patients treated for bone metastasis. The phantom study consisted of applying known offsets and evaluating the ETX level of accuracy, where results were compared with kV-cone beam computed tomography (kV-CBCT). Two groups of patients, 10 spinal and 9 nonspinal SBRT cases, were analyzed to evaluate ETX imaging for different bone localisations. A comparison was made between kV-CBCT and ETX prior to the treatment fractions. During treatments, two other kV-CBCT/ETX image pairs were also acquired and a total of 224 shifts were compared. A second study, using the ETX monitoring module, analyzed the intrafraction motion of 8 other patients. In the phantom study, the root mean square (RMS) of the translational and rotational discrepancies between ETX and kV-CBCT were < 0.6 mm and < 0.4°, respectively. For both groups of patients, the RMS of the discrepancies observed between the two imaging systems were greater than the phantom experiment while still remaining < 1 mm and < 0.7°. In the nonspinal group, three patients (2 scapulas and 1 humerus) did not have consistent shift values with ETX due to a lack of anatomical information. When ETX monitoring was used during irradiation, the setup errors measured were on average less than 1 mm/1°. The results obtained validated the use of ETX for 6D image guidance during bone SBRT. Real-time tracking of the target position improves the accuracy of the irradiation. This strategy allowed for faster correction of out-of-tolerance positioning errors. The registration of bone lesions with poor anatomical information is a limitation of this 2D-kV imaging system.
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8
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González AS, Llombart-Blanco R, Angulo MG, Tomé CV, Olmos-García MA. Clinical Outcome and Histological Findings After Induced Leakage of PMMA Loaded With Methotrexate and Cisplatin During Vertebroplasty: Experimental Model in Pigs. Global Spine J 2023; 13:156-163. [PMID: 33601909 PMCID: PMC9837504 DOI: 10.1177/2192568221994800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Animal experimental model. OBJECTIVE To study the clinical behavior and histological changes in the spinal cord, nerve roots and perivertebral muscles of the spine after induced leakage of polymethylmethacrylate (PMMA) loaded with antiblastic drugs during vertebroplasty in an animal model of pigs. METHODS We performed vertebroplasty on 25 pigs. The animals were divided into 3 groups: vertebroplasty with PMMA alone (control group), vertebroplasty with PMMA loaded with methotrexate (MTX) and vertebroplasty with PMMA loaded with cisplatin (CYS). At 2 vertebral levels, epidural and prevertebral, massive cement leaks were induced. Animals were evaluated daily. Two weeks later, the pigs were sacrificed, and the tissues that came in contact with the cement were analyzed. RESULTS The clinical results for each of the groups were reported. The control group had no clinical alterations. In the MTX group, 2 pigs died before 1 week due to pneumonitis. In the CYS group, 4 animals had motor impairment, and 3 of the 4 had paraplegia. The histological results were as follows: the control and MTX groups showed synovial metaplasia, inflammatory reaction, crystal deposits, and giant cell reaction in the dura mater and muscle and all the animals in the CYS group had spinal cord and muscular necrosis. CONCLUSIONS Massive cement leak after vertebroplasty with PMMA loaded with cisplatin is extremely toxic to the spinal cord and muscles around the spine. Therefore, its use cannot be recommended for the treatment of vertebral metastases. Using PMMA loaded with methotrexate seems to be a safe procedure, but further research is needed.
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Affiliation(s)
- Alvaro Silva González
- Department of Orthopedic Surgery,
University of Navarra, Pamplona, Spain,Department of Orthopedic Surgery, German
Clinic of Santiago, Universidad del Desarrollo, Chile
| | - Rafael Llombart-Blanco
- Department of Orthopedic Surgery,
University of Navarra, Pamplona, Spain,Rafael Llombart Blanco, Department of
Orthopedic Surgery, Clínica Universidad de Navarra, Avd. Pio XII 36, 31008
Pamplona, Navarra 31006, Spain.
| | | | - Carlos Villas Tomé
- Department of Orthopedic Surgery,
University of Navarra, Pamplona, Spain
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Wang HH, Tian SS, Yang JM, Sun BS, Chen Y, Song YC, Dong Y, Wang JS, Yuan ZY, Cui YL, Meng MB. Risk-adapted stereotactic body radiotherapy for patients with cervical spinal metastases. Cancer Sci 2022; 113:4277-4288. [PMID: 36056609 DOI: 10.1111/cas.15559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 12/15/2022] Open
Abstract
Owing to the complex anatomical structure and biomechanics, the current standard palliative treatments for cervical spinal metastases are associated with a high risk of recurrence and complications. Stereotactic body radiotherapy (SBRT) can provide radical dose to tumors while protecting normal organs to the maximum extent. However, the efficacy and safety of SBRT for cervical spinal metastases is not well characterized. Data from 71 patients with cervical spine metastases who were treated with SBRT using CyberKnife between 2006 and 2021 were obtained from our prospectively maintained database. Primary endpoint was pain response at 12 weeks following SBRT completion; secondary endpoints included local control (LC), overall survival (OS), and adverse events. Standard-risk patients were planned to receive 30 Gy (range 21-36) with median fractions of 3 (range 1-3) and high-risk patients 35 Gy (range 24-50) with median fractions of 5 (range 4-5) according to the spinal cord and esophagus dose constraints. The median follow-up time was 17.07 months (range 3.1-118.9). After 12 weeks of SBRT completion, 54 (98.2%) of 55 patients with baseline pain achieved pain response and 46 (83.6%) achieved complete pain response. LC rates were 93.1% and 90% at 1 year and 2 year, respectively. The 1-year and 2-year OS rates were 66.2% and 37.4%, respectively. Eight patients experienced grades 1-4 adverse events (six vertebral compression fracture [VCF], five of them had VCF before SBRT; and two hemiparesis). No grade 5 adverse events were observed. Therefore, risk-adapted SBRT for cervical spine metastases achieved high pain control and LC rates with acceptable adverse events.
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Affiliation(s)
- Huan-Huan Wang
- Department of Radiotherapy and CyberKnife Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Shou-Sen Tian
- Department of Radiotherapy and CyberKnife Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Jia-Min Yang
- Department of Radiotherapy and CyberKnife Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Bing-Sheng Sun
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Ying Chen
- Department of Gynaecological Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Yong-Chun Song
- Department of Radiotherapy and CyberKnife Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Yang Dong
- Department of Radiotherapy and CyberKnife Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Jing-Sheng Wang
- Department of Radiotherapy and CyberKnife Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Zhi-Yong Yuan
- Department of Radiotherapy and CyberKnife Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Yao-Li Cui
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Mao-Bin Meng
- Department of Radiotherapy and CyberKnife Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
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10
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Guo L, Ke L, Zeng Z, Yuan C, Wu Z, Chen L, Lu L. Stereotactic body radiotherapy for spinal metastases: a review. Med Oncol 2022; 39:103. [DOI: 10.1007/s12032-021-01613-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/19/2021] [Indexed: 02/05/2023]
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11
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Rogé M, Henni AH, Neggaz YA, Mallet R, Hanzen C, Dubray B, Colard E, Gensanne D, Thureau S. Evaluation of a Dedicated Software "Elements™ Spine SRS, Brainlab ®" for Target Volume Definition in the Treatment of Spinal Bone Metastases With Stereotactic Body Radiotherapy. Front Oncol 2022; 12:827195. [PMID: 35646624 PMCID: PMC9133331 DOI: 10.3389/fonc.2022.827195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/28/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction Stereotactic body radiotherapy (SBRT) is a treatment option for spine metastases. The International Spine Radiosurgery Consortium (ISRC) has published consensus guidelines for target delineation in spine SBRT. A new software called Elements™ Spine SRS by Brainlab® that includes the module Elements SmartBrush Spine (v3.0, Munich, Germany) has been developed specifically for SBRT treatment of spine metastases, and the latter provides the ability to perform semiautomatic clinical target volume (CTV) generation based on gross tumor volume (GTV) localization and guidelines. The aims of our study were to evaluate this software by studying differences in volumes between semiautomatic CTV contours compared to manual contouring performed by an expert radiation oncologist and to determine the dosimetric impact of these differences on treatment plans. Methods A total of 35 volumes ("Expert GTV" and "Expert CTV") from 30 patients were defined by a single expert. A semiautomatic definition of these 35 CTVs based on the location of "Expert GTV" and following ISRC guidelines was also performed in Elements SmartBrush Spine ("Brainlab CTV"). The spatial overlap between "Brainlab" and "Expert" CTVs was calculated using the Dice similarity coefficient (DSC). We considered a threshold of 0.80 or above to indicate that Elements SmartBrush Spine performed very well with adequate contours for clinical use. Two dosimetric treatment plans, each corresponding to a specific planning target volume (PTV; Expert PTV, Brainlab PTV), were created for 11 patients. Results We showed that "Brainlab CTV" and "Expert CTV" mean volumes were 29.8 ± 16.1 and 28.7 ± 15.7 cm3, respectively (p = 0.23). We also showed that the mean DSC for semiautomatic contouring relative to expert manual contouring was 0.85 ± 0.08 and less than 0.80 in five cases. For metastases involving the vertebral body only (n = 13,37%), the mean DSC was 0.90 ± 0.03, and for ones involving other or several vertebral regions (n = 22.63%), the mean DSC was 0.81 ± 0.08 (p < 0.001). The comparison of dosimetric treatment plans was performed for equivalent PTV coverage. There were no differences between doses received by organs at risk (spinal cord and esophagus) for Expert and Brainlab PTVs, respectively. Conclusion The results showed that the semiautomatic method had quite good accuracy and can be used in clinical routine even for complex lesions.
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Affiliation(s)
- Maximilien Rogé
- Départment of Radiation Oncology, Centre Henri Becquerel, Rouen, France
| | - Ahmed Hadj Henni
- Départment of Radiation Oncology, Centre Henri Becquerel, Rouen, France
| | | | - Romain Mallet
- Départment of Radiation Oncology, Centre Henri Becquerel, Rouen, France
| | - Chantal Hanzen
- Départment of Radiation Oncology, Centre Henri Becquerel, Rouen, France
| | - Bernard Dubray
- Départment of Radiation Oncology, Centre Henri Becquerel, Rouen, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, France
| | - Elyse Colard
- Départment of Radiation Oncology, Centre Henri Becquerel, Rouen, France
| | - David Gensanne
- Départment of Radiation Oncology, Centre Henri Becquerel, Rouen, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, France
| | - Sébastien Thureau
- Départment of Radiation Oncology, Centre Henri Becquerel, Rouen, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, France
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12
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Hemmatazad H, Mathier E, Aebersold DM, Shelan M. [Single dose of 24 Gy or 3-fraction SBRT regimen in the treatment of oligometastatic cancer? : A phase III multi-center trial]. Strahlenther Onkol 2021; 197:859-861. [PMID: 34189598 DOI: 10.1007/s00066-021-01806-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Hossein Hemmatazad
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Etienne Mathier
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
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13
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Hadj Henni A, Gensanne D, Roge M, Hanzen C, Bulot G, Colard E, Thureau S. Evaluation of inter- and intra-fraction 6D motion for stereotactic body radiation therapy of spinal metastases: influence of treatment time. Radiat Oncol 2021; 16:168. [PMID: 34461953 PMCID: PMC8404277 DOI: 10.1186/s13014-021-01892-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background The objective of this study was to analyze the amplitude of translational and rotational movements occurring during stereotactic body radiotherapy (SBRT) of spinal metastases in two different positioning devices. The relevance of intra-fractional imaging and the influence of treatment time were evaluated.
Methods Twenty patients were treated in the supine position either (1) on a body vacuum cushion with arms raised and resting on a clegecel or (2) on an integrated SBRT solution consisting of a SBRT table top, an Orfit™ AIO system, and a vacuum cushion. Alignments between the cone beam computed tomography (CBCT) and the planning computed tomography allowed corrections of inter- and intra-fraction positional shifts using a 6D table. The absolute values of the translational and rotational setup errors obtained for 329 CBCT were recorded. The translational 3D vector, the maximum angle, and the characteristic times of the treatment fractions were calculated. Results An improvement in the mean (SD) inter-fraction 3D vector (mm) from 7.8 (5.9) to 5.9 (3.8) was obtained by changing the fixation devices from (1) to (2) (p < 0.038). The maximum angles were less than 2° for a total of 87% for (1) and 96% for (2). The mean (SD) of the intra-fraction 3D vectors (mm) was lower for the new 1.1 (0.8) positioning fixation (2) compared to the old one (1) 1.7 (1.7) (p = 0.004). The angular corrections applied in the intra-fraction were on average very low (0.4°) and similar between the two systems. A strong correlation was found between the 3D displacement vector and the fraction time for (1) and (2) with regression coefficients of 0.408 (0.262–0.555, 95% CI) and 0.069 (0.010–0.128, 95% CI), respectively. An accuracy of 1 mm would require intra-fraction imaging every 5 min for both systems. If the expected accuracy was 2 mm, then only system (2) could avoid intra-fractional imaging. Conclusions This study allowed us to evaluate setup errors of two immobilization devices for spine SBRT. The association of inter- and intra-fraction imaging with 6D repositioning of a patient is inevitable. The correlation between treatment time and corrections to be applied encourages us to move toward imaging modalities which allow a reduction in fraction time.
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Affiliation(s)
| | - David Gensanne
- Centre Henri Becquerel, 1 Rue d'Amiens, 76000, Rouen, France
| | - Maximilien Roge
- Centre Henri Becquerel, 1 Rue d'Amiens, 76000, Rouen, France
| | - Chantal Hanzen
- Centre Henri Becquerel, 1 Rue d'Amiens, 76000, Rouen, France
| | - Guillaume Bulot
- Centre Henri Becquerel, 1 Rue d'Amiens, 76000, Rouen, France
| | - Elyse Colard
- Centre Henri Becquerel, 1 Rue d'Amiens, 76000, Rouen, France
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14
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Pérez-Montero H, Godino O, Lozano A, Asiáin L, Martínez I, Sánchez JJ, de BlasFernández R, Fernández E, Stefanovic M, García N, Martínez J, Guedea F, Navarro-Martin A. Long-term outcomes of spinal SBRT. Is it important to select the treatment time? Clin Transl Oncol 2021; 24:276-287. [PMID: 34342817 DOI: 10.1007/s12094-021-02684-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE SBRT (stereotactic body radiation therapy) is widely used as a curative treatment in tumoral lesions and has become a fundamental tool for the treatment of spine metastasis. In this study, we present survival and toxicity outcomes of spine SBRT after a 2-year follow-up. METHODS/PATIENTS Data from spine SBRT treatments performed at our institution between March 2012 and February 2020 was collected. Medical records, including demographic, primary tumor, and treatment characteristics were reviewed. Patient follow-up included clinical evaluation, imaging, and blood tests. Toxicity was recorded according to CTCAE v4.0. RESULTS We analyzed 73 consecutive spine SBRT treatments in 60 patients. 39.7% of the cases had primary breast cancer and 23.3% had prostate cancer. Most cases (87.7%) were treated with a single SBRT fraction of 16 Gy. Median follow-up was 26.1 months (range 1.7-78.6), and 1- and 2-year overall survival (OS) rates were 96.9% and 84.2%, respectively. Local control (LC) rates at 1- and 2-years were 76.3% and 70.6%, respectively. Multivariate analysis identified histology as a prognostic factor for both OS and LC. Patients who underwent spine SBRT 6 months after the spinal lesion diagnosis had LC at 2 years of 88%, vs 61.7% for those who underwent SBRT before this period. No grade III or higher toxicity was reported. The vertebral compression fracture (VCF) rate was 4.1%. CONCLUSION Spine SBRT at our institution showed a 2-year LC of 70.6%, without G3 toxicities. Delaying SBRT at least 6 months to administer systemic treatment was related to an improvement in local control.
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Affiliation(s)
- H Pérez-Montero
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - O Godino
- Neurosurgery Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Lozano
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - L Asiáin
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - I Martínez
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - J J Sánchez
- Radiodiagnostic Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - R de BlasFernández
- Medical Physics and Radiation Protection Department, Institut Català D'Oncologia, Barcelona, Spain
| | - E Fernández
- Physical Medicine and Rehabilitation Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - M Stefanovic
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - N García
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - J Martínez
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - F Guedea
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - A Navarro-Martin
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain.
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15
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Ehret F, Mose L, Kufeld M, Fürweger C, Windisch P, Haidenberger A, Schichor C, Tonn JC, Muacevic A. Image-Guided Robotic Radiosurgery for the Treatment of Same Site Spinal Metastasis Recurrences. Front Oncol 2021; 11:642314. [PMID: 34123794 PMCID: PMC8193921 DOI: 10.3389/fonc.2021.642314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background Due to recent medical advancements, patients suffering from metastatic spinal disease have a prolonged life expectancy than several decades ago, and some will eventually experience relapses. Data for the retreatment of spinal metastasis recurrences occurring at the very same macroscopic spot as the initially treated lesion are limited. Previous studies mainly included recurrences in the boundary areas as well as other macroscopic parts of the initially affected vertebrae. This study exclusively analyzes the efficacy and safety of spinal reirradiation for recurrences on the same site utilizing single-session robotic radiosurgery. Materials and Methods Patients between 2005 and 2020 who received radiotherapy for a spinal metastasis suffering from a local recurrence were eligible for analysis. Only patients undergoing a single-session reirradiation were included. All recurrences must have been occurred in the same location as the initial lesion. This was defined as a macroscopic recurrence on computed tomography occurring at the same site as the initial spinal metastasis. All other lesions, including those in the boundary areas or other parts of the initially affected vertebrae, were excluded. Results Fifty-three patients with fifty-three lesions were retreated for spinal metastases. The median dose and number of fractions for the initial radiotherapy were 36 Gy and 15, respectively. Eleven patients were initially treated with stereotactic body radiotherapy. Retreatment was performed with a median dose of 18 Gy prescribed to a median isodose of 70%. The local control was 77% after a median follow-up of 22.2 months. Patients experiencing a second recurrence received a lower dose (p = 0.04), mostly below 18 Gy, and had a worse coverage (p = 0.01) than those showing local tumor control. 51% of patients experienced an improvement in pain control after treatment delivery. Besides, four vertebral compression fractures (7% of patients) but no other adverse events higher than grade 2 were observed. Conclusion Single-session robotic radiosurgery appears to be a safe, time-saving, and effective treatment modality for spinal metastasis recurrences occurring in the same initial location if a considerable dose and coverage can be applied. Treatment results are comparable to reirradiated metastases in the boundary areas.
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Affiliation(s)
- Felix Ehret
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany.,European Cyberknife Center, Munich, Germany
| | - Lucas Mose
- European Cyberknife Center, Munich, Germany
| | | | - Christoph Fürweger
- European Cyberknife Center, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Paul Windisch
- European Cyberknife Center, Munich, Germany.,Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Christian Schichor
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
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16
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Park J, Yea JW, Park JW, Oh SA. Evaluation of the setup discrepancy between 6D ExacTrac and cone beam computed tomography in spine stereotactic body radiation therapy. PLoS One 2021; 16:e0252234. [PMID: 34043724 PMCID: PMC8158872 DOI: 10.1371/journal.pone.0252234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/11/2021] [Indexed: 12/31/2022] Open
Abstract
The objective of this study was to analyze the difference in residual setup errors between 6D ExacTrac and 3D cone-beam computed tomography (CBCT) image-guided systems in spinal stereotactic body radiation therapy (SBRT). We investigated 76 patients with spinal tumors who received SBRT using Novalis Tx at our institution between January 2013 and September 2020. A Vac-lok (EZ-FIX®, Arlico Medical Company, South Korea) fixture and an assistive device, based on the region involved, were used to immobilize patients and to increase the inter-fractional setup reproducibility. The difference in the root mean square (RMS) between the 6D ExacTrac and 3D CBCT was -0.75 mm, 0.45 mm, 0.16 mm, and -0.03°; the RMS value was 1.31 mm, 1.06 mm, 0.87 mm, and 0.64°; and the standard deviation was 0.80 mm, 0.72 mm, 0.62 mm, and 0.44° for lateral, longitudinal, vertical, and yaw directions, respectively. The difference in the average RMS between ExacTrac and CBCT was <1.03 mm in the translation direction and <0.47° in the rotational direction; the results were statistically significant in the lateral, longitudinal, and vertical directions, but not in the yaw direction. Thus, it is necessary to verify the ExacTrac image according to the CBCT image.
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Affiliation(s)
- Jaehyeon Park
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, South Korea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Ji Woon Yea
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, South Korea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Jae Won Park
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, South Korea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Se An Oh
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, South Korea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, South Korea
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17
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Gong Y, Zhuang H, Chong S, Shi Q, Wei F, Liu Z, Ouyang H, Liu X, Jiang L. Delayed postoperative radiotherapy increases the incidence of radiographic local tumor progression before radiotherapy and leads to poor prognosis in spinal metastases. Radiat Oncol 2021; 16:21. [PMID: 33482844 PMCID: PMC7825226 DOI: 10.1186/s13014-020-01740-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/26/2020] [Indexed: 12/28/2022] Open
Abstract
Background Most previous studies focused on the minimum interval between surgery and radiotherapy in spinal metastases, leaving the maximum interval under-investigated. However, in real world, limited radiotherapist and equipment cannot meet the needs of a large patient population to obtain timely radiotherapy after the index spine surgery in developing countries. This study aimed to estimate the clinical risks of delayed radiotherapy after surgery in patients with spinal metastases in developing country. Methods Data from 89 patients who underwent surgery and postoperative radiotherapy at a single site in a developing country were retrospectively reviewed. Patients were divided into the progression before radiotherapy (PBR) and no progression before radiotherapy (NPBR) groups. Kaplan–Meier analysis and log-rank tests were used to compare the local control (LC) and overall survival (OS) between groups. Results Within 1 month after surgery, only 20.2% of patients underwent radiotherapy. Risk of local progression before radiotherapy at 1, 3, and 6 months was 1.2%, 24.1%, and 45.1%, respectively. The LC rate at 1 year was lower in the PBR group than in the NPBR group (53.3% vs. 76.3%, P = 0.040). The OS rate at 1 year was 61.9% and 79.6% in the PBR and NPBR groups, respectively (P = 0.001). The Karnofsky performance status significantly improved only in the NPBR group (52.5 ± 17.6 vs. 66.8 ± 26.3, P < 0.001). The sphincter dysfunction significantly improved in the NPBR group (0.3 ± 0.5 vs. 0.1 ± 0.3, P = 0.007) but it tended to be deteriorated in the PBR group (0.1 ± 0.4 vs. 0.3 ± 0.5, P = 0.500). Conclusions In real world, about 80% of patients had delayed radiotherapy 1 month after spine surgery for metastases in our developing country. Patients had a higher risk for radiographic local progression before radiotherapy and poorer LC, OS, and quality of life as time to radiotherapy increased.
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Affiliation(s)
- Yining Gong
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.,Health Science Center, Peking University, Beijing, China
| | - Hongqing Zhuang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Shan Chong
- Health Science Center, Peking University, Beijing, China
| | - Qianyu Shi
- Health Science Center, Peking University, Beijing, China
| | - Feng Wei
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hanqiang Ouyang
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China. .,The Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Beijing, China.
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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18
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Gong Y, Wang C, Liu H, Liu X, Jiang L. Only Tumors Angiographically Identified as Hypervascular Exhibit Lower Intraoperative Blood Loss Upon Selective Preoperative Embolization of Spinal Metastases: Systematic Review and Meta-Analysis. Front Oncol 2021; 10:597476. [PMID: 33585214 PMCID: PMC7874195 DOI: 10.3389/fonc.2020.597476] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/02/2020] [Indexed: 01/25/2023] Open
Abstract
Background The role of preoperative embolization (PE) in reducing intraoperative blood loss (IBL) during surgical treatment of spinal metastases remains controversial. Methods A systematic search was conducted for retrospective studies and randomized controlled trials (RCTs) comparing the IBL between an embolization group (EG) and non-embolization group (NEG) for spinal metastases. IBL data of both groups were synthesized and analyzed for all tumor types, hypervascular tumor types, and non-hypervascular tumor types. Results In total, 839 patients in 11 studies (one RCT and 10 retrospective studies) were included in the analysis. For all tumor types, the average IBL did not differ significantly between the EG and NEG in the RCT (P = 0.270), and there was no significant difference between the two groups in the retrospective studies (P = 0.05, standardized mean difference [SMD] = −0.51, 95% confidence interval [CI]: −1.03 to 0.00). For hypervascular tumors determined as such by consensus (n = 542), there was no significant difference between the two groups (P = 0.52, SMD = −0.25, 95% CI: −1.01 to 0.52). For those determined as such using angiographic evidence, the IBL was significantly lower in the EG than in the NEG group, in the RCT (P = 0.041) and in the retrospective studies (P = 0.004, SMD = −0.93, 95% CI: −1.55 to −.30). For IBL of non-hypervascular tumor types, both the retrospective study (P = 0.215) and RCT (P = 0.947) demonstrated no statistically significant differences in IBL between the groups. Conclusions Only tumors angiographically identified as hypervascular exhibited lower IBL upon PE in this study. Further exploration of non-invasive methods to identify the vascularity of tumors is warranted.
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Affiliation(s)
- Yining Gong
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.,Health Science Center, Peking University, Beijing, China
| | - Changming Wang
- Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China
| | - Hua Liu
- Health Science Center, Peking University, Beijing, China
| | - Xiaoguang Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Liang Jiang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
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Gong Y, Hu J, Jiang L, Zhuang H, Wei F, Liu Z, Ni K, Bian W, Wu Y, Liu X. What Predicts the Prognosis of Spinal Metastases in Separation Surgery Procedures? World Neurosurg 2020; 146:e714-e723. [PMID: 33171322 DOI: 10.1016/j.wneu.2020.10.172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Separation surgery is performed to provide a safe gap between the epidural tumor and spinal cord for postoperative stereotactic body radiotherapy (SBRT) in cases of spinal metastases. However, there is a gap in evidence regarding sufficient tumor resection in separation surgery. We describe the prognoses according to the extent of resection in separation surgery. METHODS This retrospective study included 36 consecutive patients who underwent separation surgery and postoperative SBRT between December 2016 and December 2019 at a single center. Local control (LC), overall survival (OS), distance of separation (DS), and quality-of-life parameters were analyzed. P values <0.05 were considered statistically significant. RESULTS Patients were assigned to the aggressive resection group (ARG, n = 18) or moderate resection group (MRG, n = 18), with estimated LC and OS at 1 year of 79.0% and 75.9%, respectively. There were no significant differences between ARG and MRG in estimated LC (85.9% vs. 72.2%; P = 0.317) or OS (69.3% vs. 80.9%, P = 0.953) at 1 year. All 5 patients in MRG who developed local progression had less satisfactory tumor resection with DS <3 mm. A borderline significant difference in estimated LC at 1 year was noted between individuals with DS <3 mm and those with DS ≥3 mm (51.9% vs. 100.0%; P = 0.053) in MRG. There was no statistical difference between ARG and MRG in quality-of-life parameters. CONCLUSIONS Moderate resection of ventral dural mass did not significantly reduce patients' prognosis in separation surgery. However, the minimal distance between the postoperative residual epidural tumor and spinal cord should be ≥3 mm.
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Affiliation(s)
- Yining Gong
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; Health Science Center, Peking University, Beijing, China
| | - Jinxin Hu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; Health Science Center, Peking University, Beijing, China
| | - Liang Jiang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Hongqing Zhuang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Feng Wei
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Zhongjun Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Kaiwen Ni
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Wenjie Bian
- Health Science Center, Peking University, Beijing, China
| | - Yejun Wu
- Health Science Center, Peking University, Beijing, China
| | - Xiaoguang Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
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20
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Lin M, Qu M, Huang W, Liu T, Duan R, Yuan Y, Gao J, Zhang M, Yu X. Clinical effectiveness of percutaneous vertebroplasty in conjunction with postoperative radiotherapy in the treatment of spinal metastases. J Cancer Res Clin Oncol 2020; 147:835-844. [PMID: 32876746 DOI: 10.1007/s00432-020-03371-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/19/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to evaluate the clinical effects of percutaneous vertebroplasty (PVP) combined with postoperative radiotherapy (RT) in the treatment of spinal metastases. METHODS Nine patients (4 males and 5 females, mean age 59.56 years) with painful pathologic compression vertebral fractures caused by metastatic cancers of the spine (5 thoracic levels, 8 lumbar levels) were admitted to our hospital between July 17, 2016 and September 25, 2018. All patients were treated with PVP via bilateral pedicle approach combined with postoperative RT to treat metastatic lesions of the centrum. The clinical records of the patients were retrospectively analyzed. Patients' demographic features and medical conditions including the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and Imageology data were observed. RESULTS Patients' mean VAS scores decreased from 8.67 ± 0.50 preoperatively to 1.78 ± 0.83 at 6 months after PVP. Moreover, the mean ODI score decreased from 74.07 ± 13.15 preoperatively to 31.87 ± 10.00 at 6 months after PVP. Significant improvement in the degree of pain and dysfunction among the enrolled patients were observed. Furthermore, the metastatic carcinoma lesion within the vertebral body was well controlled according to imaging. CONCLUSION PVP in conjunction with postoperative RT is a good treatment strategy for vertebral compression fractures caused by metastases.
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Affiliation(s)
- Miaoman Lin
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Mingjia Qu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Wei Huang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Tao Liu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Ruimeng Duan
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Yashuai Yuan
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Junxiao Gao
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Meng Zhang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Xiaobing Yu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China.
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Gong Y, Xu L, Zhuang H, Jiang L, Wei F, Liu Z, Li Y, Yu M, Ni K, Liu X. Efficacy and safety of different fractions in stereotactic body radiotherapy for spinal metastases: A systematic review. Cancer Med 2019; 8:6176-6184. [PMID: 31489788 PMCID: PMC6797563 DOI: 10.1002/cam4.2546] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/28/2019] [Accepted: 08/23/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In the treatment of spinal metastases, stereotactic body radiotherapy (SBRT) delivers precise, high-dose radiation to the target region while sparing the spinal cord. A range of doses and fractions had been reported; however, the optimal prescribed scheme remains unclear. METHODS Two reviewers performed independent literature searches of the PubMed, EMBASE, Cochrane Database, and Web of Science databases. Articles were divided into one to five fractions groups. The Methodological Index for Non-randomized Studies (MINORS) was used to assess the quality of studies. Local control (LC) and overall survival (OS) were presented for the included studies and a pooled value was calculated by the weighted average. RESULTS The 38 included studies comprised 3,754 patients with 4,731 lesions. The average 1-year LCs for the one to five fractions were 92.7%, 84.6%, 86.8%, 82.6%, and 80.6%, respectively. The average 1-year OS for the one to five fractions were 53.0%, 70.4%, 60.1%, 48%, and 80%, respectively. The 24 Gy/single fraction scheme had a higher 1-year LC (98.1%) than those of 24 Gy/two fractions (85.4%), 27 Gy/three fractions (84.9%), and 24 Gy/three fractions (89.0%). The incidence of vertebral compression fracture was 10.3%, with 10.7% in the single-fraction group and 10.1% in the multi-fraction group. The incidence of radiation-induced myelopathy was 0.19%; three and two patients were treated with single-fraction and multi-fraction SBRT, respectively. The incidence of radiculopathy was 0.30% and all but one patient were treated with multi-fraction SBRT. CONCLUSIONS SBRT provided satisfactory efficacy and acceptable safety for spinal metastases. Single-fraction SBRT demonstrated a higher local control rate than those of the other factions, especially the 24 Gy dose. The risk of vertebral compression fracture (VCF) was slightly higher in single-fraction SBRT and more patients developed radiculopathy after multi-fraction SBRT.
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Affiliation(s)
- Yining Gong
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Lingyi Xu
- Eight-Year-Program, Grade 2015, Health Science Center, Peking University, Beijing, China
| | - Hongqing Zhuang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Feng Wei
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Yan Li
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Miao Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Kaiwen Ni
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
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