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Taori S, Adida S, Tang A, Rajan A, Sefcik RK, Burton SA, Flickinger JC, Zinn PO, Gerszten PC. The role of spine stereotactic radiosurgery for patients with breast cancer metastases. J Neurooncol 2024; 167:257-266. [PMID: 38355870 DOI: 10.1007/s11060-024-04599-1] [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: 01/12/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE Breast cancer that metastasizes to the spine is associated with low quality of life and poor survival. Radiosurgery has an increasing role in this patient population. This single-institution (2003-2023) study analyzes clinical outcomes and prognostic factors for patients who underwent spinal stereotactic radiosurgery (SSRS) for metastatic breast cancer. METHODS Ninety patients (155 unique breast cancer spinal metastases) were treated with SSRS. The median age was 57 years (range: 35-88), and the median KPS was 80 (range: 40-100). Forty-two (27%) lesions were managed surgically prior to radiosurgery. At SSRS, 75 (48%) lesions impinged or compressed the spinal cord per the epidural spinal cord scale (ESCC). Seventy-nine (51%) lesions were categorized as potentially unstable or unstable by the Spinal Instability Neoplastic Score (SINS). RESULTS The median follow-up was 15 months (range: 1-183). The median single-session tumor volume was 25.4 cc (range: 2-197), and the median single-fraction prescription dose was 17 Gy (range: 12-25). Seven (5%) lesions locally progressed. The 1-, 2-, and 5-year local control rates were 98%, 97%, and 92%, respectively. The median overall survival (OS) for the cohort was 32 months (range: 2-183). The 1-, 2-, and 5-year OS rates were 72%, 53%, and 30%, respectively. On univariate analysis, KPS ≥ 80 (p = 0.009, HR: 0.51, 95% CI: 0.31-0.84) was associated with improved OS. Patient-reported pain improved (68%), remained stable (29%), or worsened (3%) following radiosurgery. Fifteen (10%) radiation-induced toxicities were reported. CONCLUSIONS Spinal radiosurgery is a safe and highly effective long-term treatment modality for metastases to the spine that originate from breast cancer.
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Affiliation(s)
- Suchet Taori
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Samuel Adida
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Anthony Tang
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Akshath Rajan
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Roberta K Sefcik
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - Steven A Burton
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John C Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Pascal O Zinn
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
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Naessens C, Chamois J, Supiot S, Faivre JC, Arnaud A, Thureau S. Stereotactic body radiation therapy for bone oligometastases. Cancer Radiother 2024; 28:111-118. [PMID: 37838605 DOI: 10.1016/j.canrad.2023.04.006] [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: 04/15/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 10/16/2023]
Abstract
Stereotactic body radiation therapy is effective for the local management of oligometastases (at most five metastases) with a benefit in survival and local control. Most studies on the management of oligometastases focus on all oligometastatic sites in primary cancer and very few focus on a single oligometastatic site. In particular, there are few data on bone oligometastases, which represent one of the preferred sites for secondary cancer locations. This article focuses on the benefit of stereotactic radiotherapy for bone oligometastases of all cancers by histological types, and reviews the results of major studies in this field.
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Affiliation(s)
- C Naessens
- Département de radiothérapie, hôpital Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - J Chamois
- Institut de cancérologie radiothérapie Brétillien, boulevard de la Routière, 35760 Saint-Grégoire, France
| | - S Supiot
- Département de radiothérapie, institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Centre de recherche en cancéro-immunologie Nantes/Angers (CRCINA, UMR 892 Inserm), institut de recherche en santé de l'université de Nantes, Nantes, France
| | - J-C Faivre
- Département de radiothérapie, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - A Arnaud
- Département de radiothérapie, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France; Laboratoire QuantIF, EA4108-Litis, FR CNRS 3638, 1, rue d'Amiens, 76000 Rouen, France.
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Guninski RS, Cuccia F, Alongi F, Andratschke N, Belka C, Bellut D, Dahele M, Josipovic M, Kroese TE, Mancosu P, Minniti G, Niyazi M, Ricardi U, Munck Af Rosenschold P, Sahgal A, Tsang Y, Verbakel WFAR, Guckenberger M. Efficacy and safety of SBRT for spine metastases: A systematic review and meta-analysis for preparation of an ESTRO practice guideline. Radiother Oncol 2024; 190:109969. [PMID: 37922993 DOI: 10.1016/j.radonc.2023.109969] [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: 09/22/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND AND PURPOSE Advances in characterizing cancer biology and the growing availability of novel targeted agents and immune therapeutics have significantly changed the prognosis of many patients with metastatic disease. Palliative radiotherapy needs to adapt to these developments. In this study, we summarize the available evidence for stereotactic body radiotherapy (SBRT) in the treatment of spinal metastases. MATERIALS AND METHODS A systematic review and meta-analysis was performed using PRISMA methodology, including publications from January 2005 to September 2021, with the exception of the randomized phase III trial RTOG-0631 which was added in April 2023. Re-irradiation was excluded. For meta-analysis, a random-effects model was used to pool the data. Heterogeneity was assessed with the I2-test, assuming substantial and considerable as I2 > 50 % and I2 > 75 %, respectively. A p-value < 0.05 was considered statistically significant. RESULTS A total of 69 studies assessing the outcomes of 7236 metastases in 5736 patients were analyzed. SBRT for spine metastases showed high efficacy, with a pooled overall pain response rate of 83 % (95 % confidence interval [CI] 68 %-94 %), pooled complete pain response of 36 % (95 % CI: 20 %-53 %), and 1-year local control rate of 94 % (95 % CI: 86 %-99 %), although with high levels of heterogeneity among studies (I2 = 93 %, I2 = 86 %, and 86 %, respectively). Furthermore, SBRT was safe, with a pooled vertebral fracture rate of 9 % (95 % CI: 4 %-16 %), pooled radiation induced myelopathy rate of 0 % (95 % CI 0-2 %), and pooled pain flare rate of 6 % (95 % CI: 3 %-17 %), although with mixed levels of heterogeneity among the studies (I2 = 92 %, I2 = 0 %, and 95 %, respectively). Only 1.7 % of vertebral fractures required surgical stabilization. CONCLUSION Spine SBRT is characterized by a favorable efficacy and safety profile, providing durable results for pain control and disease control, which is particularly relevant for oligometastatic patients.
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Affiliation(s)
- R S Guninski
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - F Cuccia
- ARNAS Civico Hospital, Radiation Oncology Unit, Palermo, Italy
| | - F Alongi
- Advanced Radiation Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar-Verona, Italy. University of Brescia, Italy
| | - 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
| | - M Dahele
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiation Oncology and Cancer Center Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - 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
| | - T E Kroese
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - 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 PathologySapienza University of Rome, Rome; 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
| | - P Munck Af Rosenschold
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden; Medical Radiation Physics, Lund University, Lund, Sweden
| | - 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
| | - W F A R Verbakel
- Amsterdam University Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Quashie EE, Li XA, Prior P, Awan M, Schultz C, Tai A. Obtaining organ-specific radiobiological parameters from clinical data for radiation therapy planning of head and neck cancers. Phys Med Biol 2023; 68:245015. [PMID: 37903437 DOI: 10.1088/1361-6560/ad07f5] [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: 06/20/2023] [Accepted: 10/30/2023] [Indexed: 11/01/2023]
Abstract
Objective.Different radiation therapy (RT) strategies, e.g. conventional fractionation RT (CFRT), hypofractionation RT (HFRT), stereotactic body RT (SBRT), adaptive RT, and re-irradiation are often used to treat head and neck (HN) cancers. Combining and/or comparing these strategies requires calculating biological effective dose (BED). The purpose of this study is to develop a practical process to estimate organ-specific radiobiologic model parameters that may be used for BED calculations in individualized RT planning for HN cancers.Approach.Clinical dose constraint data for CFRT, HFRT and SBRT for 5 organs at risk (OARs) namely spinal cord, brainstem, brachial plexus, optic pathway, and esophagus obtained from literature were analyzed. These clinical data correspond to a particular endpoint. The linear-quadratic (LQ) and linear-quadratic-linear (LQ-L) models were used to fit these clinical data and extract relevant model parameters (alpha/beta ratio, gamma/alpha,dTand BED) from the iso-effective curve. The dose constraints in terms of equivalent physical dose in 2 Gy-fraction (EQD2) were calculated using the obtained parameters.Main results.The LQ-L and LQ models fitted clinical data well from the CFRT to SBRT with the LQ-L representing a better fit for most of the OARs. The alpha/beta values for LQ-L (LQ) were found to be 2.72 (2.11) Gy, 0.55 (0.30) Gy, 2.82 (2.90) Gy, 6.57 (3.86) Gy, 5.38 (4.71) Gy, and the dose constraint EQD2 were 55.91 (54.90) Gy, 57.35 (56.79) Gy, 57.54 (56.35) Gy, 60.13 (59.72) Gy and 65.66 (64.50) Gy for spinal cord, optic pathway, brainstem, brachial plexus, and esophagus, respectively. Additional two LQ-L parametersdTwere 5.24 Gy, 5.09 Gy, 7.00 Gy, 5.23 Gy, and 6.16 Gy, and gamma/alpha were 7.91, 34.02, 8.67, 5.62 and 4.95.Significance.A practical process was developed to extract organ-specific radiobiological model parameters from clinical data. The obtained parameters can be used for biologically based radiation planning such as calculating dose constraints of different fractionation regimens.
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Affiliation(s)
- Edwin E Quashie
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
- Department of Radiation Oncology, Brown University School of Medicine, Providence, RI 02903, United States of America
- Department of Radiation Oncology, Rhode Island Hospital, Providence, RI 02903, United States of America
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
| | - Phillip Prior
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
| | - Musaddiq Awan
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
| | - Christopher Schultz
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
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Guckenberger M, Dahele M, Ong WL, Sahgal A. Stereotactic Body Radiation Therapy for Spinal Metastases: Benefits and Limitations. Semin Radiat Oncol 2023; 33:159-171. [PMID: 36990633 DOI: 10.1016/j.semradonc.2022.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Progress in biological cancer characterization, targeted systemic therapies and multimodality treatment strategies have shifted the goals of radiotherapy for spinal metastases from short-term palliation to long-term symptom control and prevention of compilations. This article gives an overview of the spine stereotactic body radiotherapy (SBRT) methodology and clinical results of SBRT in cancer patients with painful vertebral metastases, metastatic spinal cord compression, oligometastatic disease and in a reirradiation situation. Outcomes after dose-intensified SBRT are compared with results of conventional radiotherapy and patient selection criteria will be discussed. Though rates of severe toxicity after spinal SBRT are low, strategies to minimize the risk of vertebral compression fracture, radiation induced myelopathy, plexopathy and myositis are summarized, to optimize the use of SBRT in multidisciplinary management of vertebral metastases.
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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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Stewart R, White M, Tan J, Siva S, Karroum L, David S. SABR in oligometastatic breast cancer: Current status and future directions. Breast 2021; 60:223-229. [PMID: 34739890 PMCID: PMC8579150 DOI: 10.1016/j.breast.2021.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/01/2021] [Accepted: 10/26/2021] [Indexed: 11/18/2022] Open
Abstract
Oligometastatic breast cancer (OMBC) is a heterogeneous disease with intrinsic biological diversity. It is increasingly accepted in clinical practice that patients with OMBC could be treated with the expectation of long-term disease remission. Local ablative treatments, such as radiotherapy or surgery have a role in this setting. At present, patients that may benefit are characterised by low tumour burden, long disease-free interval and the capacity to completely ablate all sites of disease. In the future, biological or genomic classifiers may help predict which patients may benefit the most from local ablative treatments. This review provides an overview of the proposed classifications of oligometastatic disease and outlines the standard systemic treatment options of endocrine therapy, chemotherapy, and immunotherapy. The evidence for localized treatment with stereotactic ablative body radiotherapy (SABR) is presented. We discuss current active trials in oligometastatic cancer and discuss potential future directions for the use of SABR in the treatment of OMBC. The oligometastatic disease state is being increasingly recognised in breast cancer. Breast cancer is a heterogenous disease with varied subtypes and treatment paths. Stereotactic ablative body radiotherapy in addition to systemic therapy has merit. Evidence suggests benefit for cure, stable disease maintenance, and symptom control. Study of targeted strategies to treat oligometastatic breast cancer is encouraged.
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Affiliation(s)
- Rachel Stewart
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia, 3000.
| | - Michelle White
- Monash Cancer Centre, 823-865 Centre Road, Bentleigh East, Victoria, 3165, Australia
| | - Jennifer Tan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia, 3000
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia, 3000; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Lama Karroum
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia, 3000
| | - Steven David
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia, 3000
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Abstract
OPINION STATEMENT Oligometastatic breast cancer, typically defined as the presence of 1-5 metastases, represents an intermediate state between locally advanced and widely metastatic disease. Emerging research suggests that oligometastatic cancer has a unique molecular signature distinct from widely metastatic disease, and that it carries a superior prognosis. Owing to its more limited capacity for widespread progression, oligometastatic disease may benefit from aggressive ablative therapy to known metastases. Options for ablation include surgical excision, radiofrequency ablation, and hypofractionated image-guided radiotherapy (HIGRT). The phase II SABR-COMET trial, which enrolled patients with oligometastatic disease of multiple histologies and randomized them to HIGRT vs. standard of care, found a notable survival advantage in favor of HIGRT. Other data suggest that HIGRT may synergize with immunotherapy by releasing powerful cytokines that increase anti-tumor immune surveillance and by recruiting tumor infiltrating lymphocytes, helping to overcome resistance to therapy. There are many ongoing trials exploring the role of ablative therapy, most notably HIGRT, with or without immunotherapy, for the treatment of oligometastatic breast cancer.We believe that patients with oligometastatic breast cancer should be offered enrollment on prospective clinical trials when possible. Outside the context of a clinical trial, we recommend that select patients with oligometastatic breast cancer be offered treatment with a curative approach, including ablative therapy to all sites of disease if it can be safely accomplished. Currently, selection criteria to consider for ablative therapy include longer disease-free interval from diagnosis to metastasis (>2 years), fewer metastases, and fewer involved organs. Undoubtedly, new data will refine or even upend our understanding of the definition and optimal management of oligometastatic disease.
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Guckenberger M, Mantel F, Sweeney RA, Hawkins M, Belderbos J, Ahmed M, Andratschke N, Madani I, Flentje M. Long-Term Results of Dose-Intensified Fractionated Stereotactic Body Radiation Therapy (SBRT) for Painful Spinal Metastases. Int J Radiat Oncol Biol Phys 2021; 110:348-357. [PMID: 33412262 DOI: 10.1016/j.ijrobp.2020.12.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To report long-term outcome of fractionated stereotactic body radiation therapy (SBRT) for painful spinal metastases. METHODS AND MATERIALS This prospective, single-arm, multicenter phase 2 clinical trial enrolled 57 patients with 63 painful, unirradiated spinal metastases between March 2012 and July 2015. Patients were treated with 48.5 Gy in 10 SBRT fractions (long life expectancy [Mizumoto score ≤4]) or 35 Gy in 5 SBRT fractions (intermediate life expectancy [Mizumoto score 5-9]). Pain response was defined as pain improvement of a minimum of 2 points on a visual analog scale, and net pain relief was defined as the sum of time with pain response (complete and partial) divided by the overall follow-up time. RESULTS All 57 patients received treatment per protocol; 32 and 25 patients were treated with 10- and 5-fraction SBRT, respectively. The median follow-up of living patients was 60 months (range, 33-74 months). Of evaluable patients, 82% had complete or partial pain response (responders) at 3 months' follow-up (primary endpoint), and pain response remained stable over 5 years. Net pain relief was 74% (95% CI, 65%-80%). Overall survival rates of 1, 3, and 5 years were 59.6% (95% CI, 47%-72%), 33.3% (95% CI, 21%-46%), and 21% (95% CI, 10%-32%), respectively. Freedom from local spinal-metastasis progression was 82% at the last imaging follow-up. Late grade-3 toxicity was limited to pain in 2 patients (nonresponders). There were no cases of myelopathy. SBRT resulted in long-term improvements of all dimensions of the 5-level EuroQol 5-Dimension Questionnaire except anxiety/depression. CONCLUSIONS Fractionated SBRT achieved durable pain response and improved quality of life at minimum late toxicity.
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Affiliation(s)
- Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Frederick Mantel
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Reinhart A Sweeney
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - Maria Hawkins
- Medical Physics and Biomedical Engineering, University College London, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Merina Ahmed
- Department of Radiation Therapy, Royal Marsden NHS Foundation Trust/Institute of Cancer Research, Sutton, United Kingdom
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Indira Madani
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Flentje
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
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Rossi E, Fiorino C, Fodor A, Deantoni C, Mangili P, Di Muzio NG, Del Vecchio A, Broggi S. Residual intra-fraction error in robotic spinal stereotactic body radiotherapy without immobilization devices. Phys Imaging Radiat Oncol 2020; 16:20-25. [PMID: 33458339 PMCID: PMC7807594 DOI: 10.1016/j.phro.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND PURPOSE Spinal stereotactic body radiotherapy (SBRT) involves large dose gradients and high geometrical accuracy is therefore required. The aim of this work was to assess residual intra-fraction error with a tracking robotic system for non-immobilized patients. Shifts from the first alignment (i.e. mimicking the unavailability of tracking) were also quantified. MATERIALS AND METHODS Forty-two patients treated for spinal metastasis (128 fractions, 4220 images) were analyzed. Residual error was quantified as the difference between translations/rotations referring to consecutive x-ray images during delivery (tracking) and to the initial set-up (no-tracking). The error distribution for each fraction/patient and the entire population was assessed for each axis/rotation angle. The impact of lesion sites, fractionation and patient's pain (VAS score) were investigated. Finally, the dosimetric impact of residual motion was quantified in the four most affected fractions. RESULTS Mean overall errors (OE) were near 0 (SD < 0.1 mm). Residual translations/rotations >1 mm/1° were found in less than 1.5%/1% of measurements. Lesion site and fractionation showed no impact. The dosimetric impact in the most affected fractions was negligible. For "no-tracking", mean OE was <1 mm/0.5°; less than 2% of displacements were >2 mm/1° within 10 min from the start of treatment with an increasing probability of shifts >2 mm over time. A significantly higher fraction of OE ≥ 2 mm was found for patients with pain in case of no-tracking. CONCLUSIONS Spine tracking with a latest-generation robotic system is highly efficient for non-immobilized patients: residual error is time independent and close to 0. For delivery times >7-8 min, tracking should be considered as mandatory for non-immobilized patients.
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Affiliation(s)
- Eleonora Rossi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Andrei Fodor
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Chiara Deantoni
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Paola Mangili
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
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Pontoriero A, Iatì G, Cacciola A, Conti A, Brogna A, Siragusa C, Ferini G, Davì V, Tamburella C, Molino L, Cambareri D, Severo C, Parisi S, Settineri N, Ielo I, Pergolizzi S. Stereotactic Body Radiation Therapy With Simultaneous Integrated Boost in Patients With Spinal Metastases. Technol Cancer Res Treat 2020; 19:1533033820904447. [PMID: 32336255 PMCID: PMC7225842 DOI: 10.1177/1533033820904447] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Stereotactic body radiation therapy in patients with spine metastases maximizes local tumor control and preserves neurologic function. A novel approach could be the use of stereotactic body radiation therapy with simultaneous integrated boost delivering modality. The aim of the present study is to report our experience in the treatment of spine metastases using a frameless radiosurgery system delivering stereotactic body radiation therapy–simultaneous integrated boost technique. The primary endpoints were the pain control and the time to local progression; the secondary ones were the overall survival and toxicity. A total of 20 patients with spine metastases and 22 metastatic sites were treated in our center with stereotactic body radiation therapy–simultaneous integrated boost between December 2007 and July 2018. Stereotactic body radiation therapy–simultaneous integrated boost treatments were delivered doses of 8 to 10 Gy in 1 fraction to isodose line of 50%. The median follow-up was 35 months (range: 12-110). The median time to local progression for all patients was not reached and the actuarial 1-, 2-, and 3-years local free progression rate was 86.36%. In 17 of 20 patients, a complete pain remission was observed and 3 of 20 patients had a partial pain remission (complete pain remission + partial pain remission: 100%). The median overall survival was 38 months (range 12-83). None of the patients experienced neither radiation adverse events (grade 1-4) nor reported pain flair reaction. None of the patients included in our series experienced vertebral compression fracture. Spine radiosurgery with stereotactic body radiation therapy–simultaneous integrated boost is safe. The use of this modality in spine metastases patients provides an excellent local control.
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Affiliation(s)
| | - Giuseppe Iatì
- Radiation Oncology Unit, A.O.U. "G. Martino", Messina, Italy
| | - Alberto Cacciola
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Alfredo Conti
- Neurosurgery Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Anna Brogna
- Medical Physics Unit, A.O.U. "G. Martino", Messina, Italy
| | | | - Gianluca Ferini
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Valerio Davì
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Consuelo Tamburella
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Laura Molino
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Domenico Cambareri
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Cesare Severo
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Silvana Parisi
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Nicola Settineri
- Medical Physics of Radiation Oncology Unit, A.O. "Papardo", Messina, Italy
| | - Isidora Ielo
- Medical Physics Unit, A.O.U. "G. Martino", Messina, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
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13
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Marazzi F, Orlandi A, Manfrida S, Masiello V, Di Leone A, Massaccesi M, Moschella F, Franceschini G, Bria E, Gambacorta MA, Masetti R, Tortora G, Valentini V. Diagnosis and Treatment of Bone Metastases in Breast Cancer: Radiotherapy, Local Approach and Systemic Therapy in a Guide for Clinicians. Cancers (Basel) 2020; 12:cancers12092390. [PMID: 32846945 PMCID: PMC7563945 DOI: 10.3390/cancers12092390] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022] Open
Abstract
The standard care for metastatic breast cancer (MBC) is systemic therapies with imbrication of focal treatment for symptoms. Recently, thanks to implementation of radiological and metabolic exams and development of new target therapies, oligometastatic and oligoprogressive settings are even more common-paving the way to a paradigm change of focal treatments role. In fact, according to immunophenotype, radiotherapy can be considered with radical intent in these settings of patients. The aim of this literature review is to analyze available clinical data on prognosis of bone metastases from breast cancer and benefits of available treatments for developing a practical guide for clinicians.
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Affiliation(s)
- Fabio Marazzi
- “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario, 00168 Roma, Italy; (F.M.); (S.M.); (M.M.); (M.A.G.); (V.V.)
| | - Armando Orlandi
- “A. Gemelli” IRCCS, UOC di Oncologia Medica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario, 00168 Roma, Italy; (A.O.); (E.B.); (G.T.)
| | - Stefania Manfrida
- “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario, 00168 Roma, Italy; (F.M.); (S.M.); (M.M.); (M.A.G.); (V.V.)
| | - Valeria Masiello
- “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario, 00168 Roma, Italy; (F.M.); (S.M.); (M.M.); (M.A.G.); (V.V.)
- Correspondence:
| | - Alba Di Leone
- “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario, 00168 Roma, Italy; (A.D.L.); (F.M.); (G.F.); (R.M.)
| | - Mariangela Massaccesi
- “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario, 00168 Roma, Italy; (F.M.); (S.M.); (M.M.); (M.A.G.); (V.V.)
| | - Francesca Moschella
- “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario, 00168 Roma, Italy; (A.D.L.); (F.M.); (G.F.); (R.M.)
| | - Gianluca Franceschini
- “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario, 00168 Roma, Italy; (A.D.L.); (F.M.); (G.F.); (R.M.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Emilio Bria
- “A. Gemelli” IRCCS, UOC di Oncologia Medica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario, 00168 Roma, Italy; (A.O.); (E.B.); (G.T.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Maria Antonietta Gambacorta
- “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario, 00168 Roma, Italy; (F.M.); (S.M.); (M.M.); (M.A.G.); (V.V.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Riccardo Masetti
- “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario, 00168 Roma, Italy; (A.D.L.); (F.M.); (G.F.); (R.M.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Giampaolo Tortora
- “A. Gemelli” IRCCS, UOC di Oncologia Medica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario, 00168 Roma, Italy; (A.O.); (E.B.); (G.T.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Vincenzo Valentini
- “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario, 00168 Roma, Italy; (F.M.); (S.M.); (M.M.); (M.A.G.); (V.V.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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14
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Singh R, Lehrer EJ, Dahshan B, Palmer JD, Sahgal A, Gerszten PC, Zaorsky NG, Trifiletti DM. Single fraction radiosurgery, fractionated radiosurgery, and conventional radiotherapy for spinal oligometastasis (SAFFRON): A systematic review and meta-analysis. Radiother Oncol 2020; 146:76-89. [PMID: 32114269 DOI: 10.1016/j.radonc.2020.01.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE To perform a systematic review/meta-analysis of outcomes for patients with spinal metastases treated with stereotactic radiosurgery (SRS) (either single-fraction (SF-SRS) or multiple-fraction (MF-SRS)) or conventional radiotherapy (RT). MATERIALS AND METHODS Thirty-seven studies were identified. Primary outcomes were 1-year local control (LC) and acute/late grade 3-5 toxicities (including vertebral compression fractures (VCF)). Weighted random effects meta-analyses using the DerSimonian and Laird methods and meta-regressions were conducted to characterize and compare effect sizes. Mixed effects regression models were used in dose analyses. RESULTS A total of 3237 patients with 4911 lesions were included; 43.8%, 19.7%, and 36.5% of lesions received SF-SRS, MF-SRS, or RT, respectively. SF-SRS resulted in improved 1-year LC (92.9% (95% CI: 86.4-97.4%); p = 0.007) compared to RT (81.0% (95% CI: 69.2-90.5%)) with no difference between MF-SRS (82.1%; p = 0.86) and RT. On subgroup analysis of de novo metastases, superior 1-year LC following SF-SRS (95.5% (95% CI: 87.4-99.6%)) was maintained compared to RT (83.6% (95% CI: 70.4-93.5%); p = 0.007). A 4.7% increase in LC was noted for each 10 Gy10 increase in biologically effective dose (BED10, assuming an alpha/beta = 10) with SRS (p < 0.001). No difference in toxicities were found between SF-SRS (0.4%), MF-SRS (0.2%), or RT (0%). Higher VCF rates were noted following SF-SRS (19.5%) vs. MF-SRS (9.6%; p = 0.039)) with no correlation between dose and VCF rates. CONCLUSION SF-SRS resulted in superior LC with a roughly 5% LC benefit for every 10 Gy10 increase in BED10 with higher VCF rates compared to MF-SRS. If LC is the goal of treatment, then SRS may be a preferred treatment modality. However, these results are hypothesis-generating, and prospective randomized clinical trials are indicated to definitively address the question of whether SRS results in improved LC compared to RT.
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Affiliation(s)
- Raj Singh
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, USA
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Basem Dahshan
- Department of Radiation Oncology, West Virginia University School of Medicine, Morgantown, USA
| | - Joshua D Palmer
- Department of Radiation Oncology and Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Hospital, Toronto, Canada
| | - Peter C Gerszten
- Departments of Neurosurgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA
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15
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Stereotactic ablative body radiotherapy (SABR) for bone only oligometastatic breast cancer: A prospective clinical trial. Breast 2019; 49:55-62. [PMID: 31734589 PMCID: PMC7375645 DOI: 10.1016/j.breast.2019.10.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Stereotactic ablative body radiotherapy (SABR) is an emerging noninvasive approach for the treatment of oligometastases. Limited prospective evidence is available in breast cancer. OBJECTIVES To determine the safety and feasibility of single fraction SABR for patients with bone only oligometastatic breast cancer. Secondary endpoints were local and distant progression-free survival (LPFS and DPFS), toxicity and response assessment. METHODS AND MATERIALS In this single institution prospective trial we screened patients with computed tomography, bone scan, and sodium fluoride positron emission tomography. Eligible patients had one to three bone only oligometastases. All patients were treated at a dose of 20Gy in 1 fraction to each metastasis. Kaplan-Meier methods were used to determine local and distant progression free survival (LPFS and DPFS). Toxicity was graded using Common Terminology Criteria for Adverse Event version 4.0. RESULTS 15 eligible patients were recruited to the study. Median follow-up time was 24 months. The treatment was feasible in 12 (80%) of patients with 3 (20%) of patients having treatment delayed by more than 3 days. 10 (67%) of patients experienced grade 1 treatment related toxicity, 4 (27%) experienced grade 2 toxicity and no patients experienced grade 3 or 4 treatment related toxicity. The two-year LPFS was 100%, DPFS was 67%. CONCLUSION We observed that SABR is feasible, well tolerated and effective in this cohort with two thirds of patients disease-free at two years. In selected patients with bone-only oligometastatic disease, SABR could be considered a treatment option. Randomised trials are required to assess the impact of SABR on overall survival when compared to the standard of care.
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16
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Spinal Nerve Tolerance to Single-Session Stereotactic Ablative Radiation Therapy. Int J Radiat Oncol Biol Phys 2019; 104:845-851. [DOI: 10.1016/j.ijrobp.2019.03.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/19/2019] [Accepted: 03/25/2019] [Indexed: 12/31/2022]
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17
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Zeng KL, Tseng CL, Soliman H, Weiss Y, Sahgal A, Myrehaug S. Stereotactic Body Radiotherapy (SBRT) for Oligometastatic Spine Metastases: An Overview. Front Oncol 2019; 9:337. [PMID: 31119099 PMCID: PMC6504814 DOI: 10.3389/fonc.2019.00337] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/12/2019] [Indexed: 12/15/2022] Open
Abstract
The oligometastatic state is hypothesized to represent an intermediary state of cancer between widely metastatic disease and curable, localized disease. Advancements in radiotherapy have allowed for delivery of high precision, dose escalated treatment known as stereotactic body radiotherapy (SBRT) to targets throughout the body with excellent rates of local control. Recently, the first phase II randomized trial comparing conventional radiotherapy to comprehensive SBRT of oligometastatic disease demonstrated an overall survival and progression free survival advantage. The spine is a common site of metastasis, and a complex site for SBRT given the adjacent spinal cord and the tumor embedded within the bone tissue putting the patient at risk of fracture. Although there are expert spine SBRT guidelines for practice, there are as yet no reported randomized trials that proves superiority as compared to conventional radiation. The use of SBRT in patients with oligometastatic disease and spinal metastases is the focus of this review.
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Affiliation(s)
- Kang Liang Zeng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yonatan Weiss
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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18
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Zhou RP, Mummaneni PV, Chen KY, Lau D, Cao K, Amara D, Zhang C, Dhall S, Chou D. Outcomes of Posterior Thoracic Corpectomies for Metastatic Spine Tumors: An Analysis of 90 Patients. World Neurosurg 2019; 123:e371-e378. [PMID: 30500586 DOI: 10.1016/j.wneu.2018.11.172] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/17/2018] [Accepted: 11/19/2018] [Indexed: 01/22/2023]
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19
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Coût de la radiothérapie des métastases osseuses en France : étude rétrospective monocentrique. Cancer Radiother 2019; 23:1-9. [DOI: 10.1016/j.canrad.2018.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/04/2018] [Accepted: 01/10/2018] [Indexed: 11/24/2022]
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20
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Volume effects in radiosurgical spinal cord dose tolerance: how small is too small? ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s13566-018-0371-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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21
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Osborn VW, Lee A, Yamada Y. Stereotactic Body Radiation Therapy for Spinal Malignancies. Technol Cancer Res Treat 2019; 17:1533033818802304. [PMID: 30343661 PMCID: PMC6198394 DOI: 10.1177/1533033818802304] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Stereotactic body radiation therapy and stereotactic radiosurgery have become important treatment options for the treatment of spinal malignancies. A better understanding of dose tolerances with more conformal technology have allowed administration of higher and more ablative doses. In this review, the framework for approaching a patient with spinal metastases and primary tumors will be discussed as well as details on the delivery of this treatment.
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Affiliation(s)
- Virginia W Osborn
- 1 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,2 Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Anna Lee
- 1 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,2 Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Yoshiya Yamada
- 1 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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22
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Le Fèvre C, Antoni D, Thiéry A, Noël G. Radiothérapie des métastases osseuses : revue multi-approches de la littérature. Cancer Radiother 2018; 22:810-825. [DOI: 10.1016/j.canrad.2017.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/20/2017] [Accepted: 10/12/2017] [Indexed: 12/18/2022]
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23
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Stereotactic radiotherapy in metastatic breast cancer. Breast 2018; 41:57-66. [DOI: 10.1016/j.breast.2018.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/09/2018] [Accepted: 06/21/2018] [Indexed: 12/19/2022] Open
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24
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Bazire L, Darmon I, Calugaru V, Costa É, Dumas JL, Kirova YM. [Technical aspects and indications of extracranial stereotactic radiotherapy]. Cancer Radiother 2018; 22:447-458. [PMID: 30064828 DOI: 10.1016/j.canrad.2017.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/10/2017] [Accepted: 09/16/2017] [Indexed: 12/25/2022]
Abstract
Extracranial stereotactic radiotherapy has developed considerably in recent years and is now an important part of the therapeutic alternatives to be offered to patients with cancer. It offers opportunities that have progressively led physicians to reconsider the therapeutic strategy, for example in the case of local recurrence in irradiated territory or oligometastatic disease. The literature on the subject is rich but, yet, there is no real consensus on therapeutic indications. This is largely due to the lack of prospective, randomized studies that have evaluated this technique with sufficient recoil. We propose a review of the literature on the technical aspects and indications of extracranial stereotactic radiotherapy.
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Affiliation(s)
- L Bazire
- Département de radiothérapie oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France.
| | - I Darmon
- Département de radiothérapie oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
| | - V Calugaru
- Département de radiothérapie oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
| | - É Costa
- Département de radiothérapie oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
| | - J-L Dumas
- Département de radiothérapie oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
| | - Y M Kirova
- Département de radiothérapie oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
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25
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Abstract
Aims and background To report pain relief effect in patients with spinal metastases treated with Cyberknife® and to analyze the factors associated with pain relapse after initial pain relief. Methods and study design. We retrospectively analyzed patients with spinal metastasis treated with stereotactic body radiosurgery between April 2007 and June 2009. A total of 57 patients with 73 lesions were available for analysis with a median follow-up of 6.8 months (range, 1–30). Pain was assessed by a verbal/visual analogue scale at each visit: from 0 to 10. Pain relief was defined as a decrease of at least three levels of the pain score without an increase in analgesic use. Complete relief was defined as no analgesics or a score 0 or 1. Results Pain relief was achieved in 88% of the lesions, with complete relief in 51% within 7 days from the start of radiosurgery. The median duration of pain relief was 3.2 months (range, 1–30). Pain reappeared in 16 patients (27%). Spinal cord compression (P = 0.001) and performance status (P = 0.01) were predictive of pain relapse by multivariate Cox analysis. All 6 patients treated with solitary spinal metastasis experienced pain relief; 5 of them were alive without evidence of disease at a median of 16 months (range, 7–30). Conclusions As previous studies have shown, our study confirms that pain relief with spinal radiosurgery is around 90%. In particular, long-term pain relief and disease control was observed in patients with solitary spinal metastasis.
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Affiliation(s)
- Sunyoung Lee
- Department of Radiation Oncology, Konyang University School of Medicine, Daejeon
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
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26
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Husain ZA, Sahgal A, De Salles A, Funaro M, Glover J, Hayashi M, Hiraoka M, Levivier M, Ma L, Martínez-Alvarez R, Paddick JI, Régis J, Slotman BJ, Ryu S. Stereotactic body radiotherapy for de novo spinal metastases: systematic review. J Neurosurg Spine 2017; 27:295-302. [DOI: 10.3171/2017.1.spine16684] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe aim of this systematic review was to provide an objective summary of the published literature pertaining to the use of stereotactic body radiation therapy (SBRT) specific to previously untreated spinal metastases.METHODSThe authors performed a systematic review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, of the literature found in a search of Medline, PubMed, Embase, and the Cochrane Library up to March 2015. The search strategy was limited to publications in the English language.RESULTSA total of 14 full-text articles were included in the analysis. All studies were retrospective except for 2 studies, which were prospective. A total of 1024 treated spinal lesions were analyzed. The median follow-up time ranged from 9 to 49 months. A range of dose-fractionation schemes was used, the most common of which were 16–24 Gy/1 fraction (fx), 24 Gy/2 fx, 24–27 Gy/3 fx, and 30–35 Gy/5 fx. In studies that reported crude results regarding in-field local tumor control, 346 (85%) of 407 lesions remained controlled. For studies that reported actuarial values, the weighted average revealed a 90% 1-year local control rate. Only 3 studies reported data on complete pain response, and the weighted average of these results yielded a complete pain response rate of 54%. The most common toxicity was new or progressing vertebral compression fracture, which was observed in 9.4% of cases; 2 cases (0.2%) of neurologic injury were reported.CONCLUSIONThere is a paucity of prospective data specific to SBRT in patients with spinal metastases not otherwise irradiated. This systematic review found that SBRT is associated with favorable rates of local control (approximately 90% at 1 year) and complete pain response (approximately 50%), and low rates of serious adverse events were found. Practice guidelines are summarized based on these data and International Stereotactic Radiosurgery Society consensus.
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Affiliation(s)
- Zain A. Husain
- 1Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Arjun Sahgal
- 2Department of Radiation Oncology, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Antonio De Salles
- 3Department of Neurosurgery, University of California, Los Angeles, California
| | - Melissa Funaro
- 4Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Janis Glover
- 4Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Motohiro Hayashi
- 5Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo
| | - Masahiro Hiraoka
- 6Department of Radiation Oncology, Kyoto University, Kyoto, Japan
| | - Marc Levivier
- 7Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lijun Ma
- 8Division of Physics, Department of Radiation Oncology, University of California, San Francisco, California
| | | | - J. Ian Paddick
- 10National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jean Régis
- 11Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Ben J. Slotman
- 12Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; and
| | - Samuel Ryu
- 13Department of Radiation Oncology, Stony Brook University, Stony Brook, New York
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27
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Abstract
Background Metastatic tumor in the spinal column is common, causing symptomatic spinal cord compression in approximately 25,000 patients annually. Although surgical treatment of spinal metastases has become safer, less invasive, and more efficacious in recent years, there remains a subset of patients for whom other treatment modalities are needed. Stereotactic radiosurgery, which has long been used in the treatment of intracranial lesions, has recently been applied to the spine and enables the effective treatment of metastatic lesions. Methods We review the evolution of stereotactic radiosurgery and its applications in the spine, including a description of two commercially available systems. Results Although a relatively new technique, the use of stereotactic radiosurgery in the spine has advanced rapidly in the past decade. Spinal stereotactic radiosurgery is an effective and safe modality for the treatment of spinal metastatic disease. Conclusions Future challenges involve the refinement of noninvasive fiducial tracking systems and the discernment of optimal doses needed to treat various lesions. Additionally, dose-tolerance limits of normal structures need to be further developed. Increased experience will likely make stereotactic radiosurgery of the spine an important treatment modality for a variety of metastatic lesions.
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Affiliation(s)
- Michael A Finn
- Spinal Oncology Service, Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City 84132, USA
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Wang X, Zhao Z, Luo D, Yang JN, Yang J, Chang EL, Brown PD, Li J, McAleer MF, Ghia AJ. Submillimeter alignment of more than three contiguous vertebrae in spinal SRS/SBRT with 6-degree couch. J Appl Clin Med Phys 2017; 18:225-236. [PMID: 28786235 PMCID: PMC5875814 DOI: 10.1002/acm2.12153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/14/2017] [Accepted: 06/21/2017] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study is to identify regions of spinal column in which more than three contiguous vertebrae can be reliably and quickly aligned within 1 mm using a 6‐degree (6D) couch and full body immobilization device. We analyzed 45 cases treated over a 3‐month period. Each case was aligned using ExacTrac x‐ray positioning system with integrated 6D couch to be within 1° and 1 mm in all six dimensions. Cone‐Beam computed tomography (CBCT) with at least 17.5 cm field of view (FOV) in the superior–inferior direction was taken immediately after ExacTrac positioning. It was used to examine the residual error of five to nine contiguous vertebrae visible in the FOV. The residual error of each vertebra was determined by expanding/contracting the vertebrae contour with a margin in millimeter integrals on the planning CT such that the new contours would enclose the corresponding vertebrae contour on CBCT. Submillimeter initial setup accuracy was consistently achieved in 98% (40/41) cases for a span of five or more vertebrae starting from T2 vertebra and extending caudally to S5. The curvature of spinal column along the cervical region and cervicothoracic junction was not easily reproducible between treatment and simulation. Fifty‐seven percent (8/14) of cases in this region had residual setup error of more than 1 mm in nearby vertebrae after alignment using 6D couch with image guidance. In conclusion, 6D couch integrated with image guidance is convenient and accurately corrects small rotational shifts. Consequently, more than three contiguous vertebrae can be aligned within 1 mm with immobilization that reliably reproduces the curvature of the thoracic and lumbar spinal column. Ability of accurate setup is becoming less a concern in limiting the use of stereotactic radiosurgery or stereotactic body radiation therapy to treat multilevel spinal target.
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Affiliation(s)
- Xin Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhongxiang Zhao
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dershan Luo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James N Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric L Chang
- Departments of Radiation Oncology, University of Southern California Keck School of Medicine, Norris Cancer Hospital, Los Angeles, CA, USA
| | - Paul D Brown
- Departments of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary F McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amol J Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Zerlauth JB, Meuli R, Dunet V. Renal cell carcinoma metastasis involving vertebral hemangioma: dual percutaneous treatment by navigational bipolar radiofrequency ablation and high viscosity cement vertebroplasty. J Neurointerv Surg 2017; 9:e34. [PMID: 28184002 DOI: 10.1136/neurintsurg-2016-012931.rep] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 11/03/2022]
Abstract
The case of a 70-year-old woman with progressive renal cell carcinoma (RCC) metastatic invasion of a L3 vertebral hemangioma treated by dual percutaneous radiofrequency ablation (RFA) and vertebroplasty is reported. The patient was surgically treated for RCC in 2001. Chemotherapy and immunotherapy were introduced in 2013 for ovarian, bladder and cerebral metastatic disease. An asymptomatic L3 benign hemangioma was noticed at this time. One-year CT and MRI follow-up studies demonstrated a nodular isolated soft tissue lesion involving the anterior edge of the hemangioma. Percutaneous treatment consisted of a L3 vertebral body unipedicular approach to perform a biopsy, RFA with a navigational bipolar RFA device and vertebroplasty using high viscosity cement. Histopathological examination confirmed metastasis of RCC. The 5-month spinal MRI and CT examinations demonstrated complete disappearance of the tumor.
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Affiliation(s)
- Jean-Baptiste Zerlauth
- Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Reto Meuli
- Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Vincent Dunet
- Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
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Zerlauth JB, Meuli R, Dunet V. Renal cell carcinoma metastasis involving vertebral hemangioma: dual percutaneous treatment by navigational bipolar radiofrequency ablation and high viscosity cement vertebroplasty. BMJ Case Rep 2017; 2017:bcr-2016-012931. [PMID: 28154154 DOI: 10.1136/bcr-2016-012931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The case of a 70-year-old woman with progressive renal cell carcinoma (RCC) metastatic invasion of a L3 vertebral hemangioma treated by dual percutaneous radiofrequency ablation (RFA) and vertebroplasty is reported. The patient was surgically treated for RCC in 2001. Chemotherapy and immunotherapy were introduced in 2013 for ovarian, bladder and cerebral metastatic disease. An asymptomatic L3 benign hemangioma was noticed at this time. One-year CT and MRI follow-up studies demonstrated a nodular isolated soft tissue lesion involving the anterior edge of the hemangioma. Percutaneous treatment consisted of a L3 vertebral body unipedicular approach to perform a biopsy, RFA with a navigational bipolar RFA device and vertebroplasty using high viscosity cement. Histopathological examination confirmed metastasis of RCC. The 5-month spinal MRI and CT examinations demonstrated complete disappearance of the tumor.
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Affiliation(s)
- Jean-Baptiste Zerlauth
- Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Reto Meuli
- Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Vincent Dunet
- Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
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Pokhrel D, Sood S, McClinton C, Shen X, Badkul R, Jiang H, Mallory M, Mitchell M, Wang F, Lominska C. On the use of volumetric-modulated arc therapy for single-fraction thoracic vertebral metastases stereotactic body radiosurgery. Med Dosim 2017; 42:69-75. [DOI: 10.1016/j.meddos.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 11/25/2016] [Accepted: 12/12/2016] [Indexed: 12/31/2022]
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Harel R, Pfeffer R, Levin D, Shekel E, Epstein D, Tsvang L, Ben Ayun M, Alezra D, Zach L. Spine radiosurgery: lessons learned from the first 100 treatment sessions. Neurosurg Focus 2017; 42:E3. [DOI: 10.3171/2016.9.focus16332] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE
Local therapy to spine tumors has been shown to be effective in selected cases. Spinal radiosurgery (SRS) is an evolving radiotherapy regimen allowing for noninvasive, highly efficacious local treatment. The learning curve can compromise the results of any newly employed technology and should be studied to minimize its effects. In this paper the first 100 SRSs performed at several medical centers are presented and analyzed for the effects of the learning curve on outcome.
METHODS
A retrospective analysis was undertaken to evaluate data from patients treated with SRS at Sheba Medical Center and Assuta Medical Centers in the period from September 2011 to February 2016. Medical history, clinical and neurological findings, pathological diagnoses, SRS variables, complications, and follow-up data were collected and analyzed. Local control rates were calculated, and local treatment failure cases were qualitatively studied.
RESULTS
One hundred treatment sessions were performed for 118 lesions at 179 spinal levels in 80 patients. The complication rate was low and did not correlate with a learning curve. Mean follow-up time was 302 days, and the overall local control rate was 95%. The local control rate was dose dependent and increased from 87% (among 35 patients receiving a dose of 16 Gy) to 97% (among 65 patients receiving a dose of 18 Gy). The 6 treatment failure cases are discussed in detail.
CONCLUSIONS
Spinal radiosurgery is a safe and effective treatment. Comprehensive education of the treating team and continuous communication are essential to limit the effects of the learning curve on outcome.
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Affiliation(s)
- Ran Harel
- 1Stereotactic Radiosurgery Unit and
- 2Spine Surgery Unit, Talpiot Medical Leadership Program, Department of Neurosurgery, Sheba Medical Center, Ramat Gan
- 3Sackler Medical School, Tel-Aviv University
| | - Raphael Pfeffer
- 4Department of Radiotherapy, Assuta Medical Centers, Tel-Aviv; and
| | - Daphne Levin
- 4Department of Radiotherapy, Assuta Medical Centers, Tel-Aviv; and
| | - Efrat Shekel
- 4Department of Radiotherapy, Assuta Medical Centers, Tel-Aviv; and
| | - Dan Epstein
- 4Department of Radiotherapy, Assuta Medical Centers, Tel-Aviv; and
| | - Lev Tsvang
- 5Radiation Oncology Unit, Oncology Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Maoz Ben Ayun
- 5Radiation Oncology Unit, Oncology Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Dror Alezra
- 5Radiation Oncology Unit, Oncology Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Leor Zach
- 3Sackler Medical School, Tel-Aviv University
- 5Radiation Oncology Unit, Oncology Institute, Sheba Medical Center, Ramat Gan, Israel
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Telera S, Caroli F, Raus L, Pompili A, Carosi MA, Di Santo M, Sperduti I, Carapella CM, Fabi A. Spine Surgery in Patients with Metastatic Breast Cancer: A Retrospective Analysis. World Neurosurg 2016; 90:133-146. [DOI: 10.1016/j.wneu.2016.02.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/10/2016] [Accepted: 02/12/2016] [Indexed: 01/19/2023]
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Yazici G, Sari SY, Yedekci FY, Yucekul A, Birgi SD, Demirkiran G, Gultekin M, Hurmuz P, Yazici M, Ozyigit G, Cengiz M. The dosimetric impact of implants on the spinal cord dose during stereotactic body radiotherapy. Radiat Oncol 2016; 11:71. [PMID: 27225270 PMCID: PMC4880816 DOI: 10.1186/s13014-016-0649-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/17/2016] [Indexed: 01/14/2023] Open
Abstract
Background The effects of spinal implants on dose distribution have been studied for conformal treatment plans. However, the dosimetric impact of spinal implants in stereotactic body radiotherapy (SBRT) treatments has not been studied in spatial orientation. In this study we evaluated the effect of spinal implants placed in sawbone vertebra models implanted as in vivo instrumentations. Methods Four different spinal implant reconstruction techniques were performed using the standard sawbone lumbar vertebrae model; 1. L2-L4 posterior instrumentation without anterior column reconstruction (PI); 2. L2-L4 anterior instrumentation, L3 corpectomy, and anterior column reconstruction with a titanium cage (AIAC); 3. L2-L4 posterior instrumentation, L3 corpectomy, and anterior column reconstruction with a titanium cage (PIAC); 4. L2-L4 anterior instrumentation, L3 corpectomy, and anterior column reconstruction with chest tubes filled with bone cement (AIABc). The target was defined as the spinous process and lamina of the lumbar (L) 3 vertebra. A thermoluminescent dosimeter (TLD, LiF:Mg,Ti) was located on the measurement point anterior to the spinal cord. The prescription dose was 8 Gy and the treatment was administered in a single fraction using a CyberKnife® (Accuray Inc., Sunnyvale, CA, USA). We performed two different treatment plans. In Plan A beam interaction with the rod was not limited. In plan B the rod was considered a structure of avoidance, and interaction between the rod and beam was prevented. TLD measurements were compared with the point dose calculated by the treatment planning system (TPS). Results and discussion In plan A, the difference between TLD measurement and the dose calculated by the TPS was 1.7 %, 2.8 %, and 2.7 % for the sawbone with no implant, PI, and PIAC models, respectively. For the AIAC model the TLD dose was 13.8 % higher than the TPS dose; the difference was 18.6 % for the AIABc model. In plan B for the AIAC and AIABc models, TLD measurement was 2.5 % and 0.9 % higher than the dose calculated by the TPS, respectively. Conclusions Spinal implants may be present in the treatment field in patients scheduled to undergo SBRT. For the types of implants studied herein anterior rod instrumentation resulted in an increase in the spinal cord dose, whereas use of a titanium cage had a minimal effect on dose distribution. While planning SBRT in patients with spinal reconstructions, avoidance of the rod and preventing interaction between the rod and beam might be the optimal solution for preventing unexpectedly high spinal cord doses.
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Affiliation(s)
- Gozde Yazici
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Sezin Yuce Sari
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Fazli Yagiz Yedekci
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Altug Yucekul
- Department of Orthopedics and Traumatology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Sumerya Duru Birgi
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Gokhan Demirkiran
- Department of Orthopedics and Traumatology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Melis Gultekin
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Muharrem Yazici
- Department of Orthopedics and Traumatology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cengiz
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Braam P, Lambin P, Bussink J. Stereotactic versus conventional radiotherapy for pain reduction and quality of life in spinal metastases: study protocol for a randomized controlled trial. Trials 2016; 17:61. [PMID: 26829933 PMCID: PMC4735957 DOI: 10.1186/s13063-016-1178-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/15/2016] [Indexed: 01/31/2023] Open
Abstract
Background Painful spinal metastases have been treated with conventional radiotherapy for decades, but one-third of the patients have insufficient pain relief after treatment and one-fifth need retreatment. Stereotactic radiotherapy is a method to increase the dose in the spinal metastases with a potentially longer lasting palliative effect without increasing the side effects of the treatment and thereby is expected to improve the quality of life significantly. Methods/Design This study is a multicenter prospective randomized clinical trial comparing conventional radiotherapy (1 x 8Gy) with stereotactic radiotherapy (1 x 20Gy) for pain reduction and quality of life in patients with painful spinal metastases. A total of 386 patients will be randomized between the two treatment groups. Besides pain measured by the Dutch Brief Pain Inventory, quality of life and cost-effectiveness also will be measured. The primary outcome is pain reduction at 6 weeks after treatment. Secondary outcomes will be the time to pain response, duration of pain relief, health-related quality of life and toxicity, as well as cost-effectiveness. Discussion This study investigates whether stereotactic radiotherapy with dose escalation for symptomatic spinal metastases can lead to improved pain reduction as compared to conventional radiotherapy without an increase of treatment-related side effects. These results will contribute to the optimization and individualization of the treatment for the patient. Trial registration ClinicalTrials.gov identifier NCT02407795 (March 31, 2015).
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Affiliation(s)
- Pètra Braam
- Department of Radiation Oncology, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 32, route 874, PB 9101, Nijmegen, GA, 6525, The Netherlands.
| | - Philippe Lambin
- MAASTRO Clinic, Doctor Tanslaan 12, 6229 ET, Maastricht, The Netherlands.
| | - Johan Bussink
- Department of Radiation Oncology, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 32, route 874, PB 9101, Nijmegen, GA, 6525, The Netherlands.
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de Moraes FY, Taunk NK, Laufer I, Neves-Junior WFP, Hanna SA, de Andrade Carvalho H, Yamada Y. Spine radiosurgery for the local treatment of spine metastases: Intensity-modulated radiotherapy, image guidance, clinical aspects and future directions. Clinics (Sao Paulo) 2016; 71:101-9. [PMID: 26934240 PMCID: PMC4760359 DOI: 10.6061/clinics/2016(02)09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/27/2015] [Indexed: 12/31/2022] Open
Abstract
Many cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is based on intensity-modulated radiotherapy, image guidance and rigid immobilization. Spinal radiosurgery is an increasingly utilized treatment method that improves local control and pain relief after delivering ablative doses of radiation. Here, we present a review highlighting the use of spinal radiosurgery for the treatment of metastatic tumors of the spine. The data used in the review were collected from both published studies and ongoing trials. We found that spinal radiosurgery is safe and provides excellent tumor control (up to 94% local control) and pain relief (up to 96%), independent of histology. Extensive data regarding clinical outcomes are available; however, this information has primarily been generated from retrospective and nonrandomized prospective series. Currently, two randomized trials are enrolling patients to study clinical applications of fractionation schedules spinal Radiosurgery. Additionally, a phase I clinical trial is being conducted to assess the safety of concurrent stereotactic body radiotherapy and ipilimumab for spinal metastases. Clinical trials to refine clinical indications and dose fractionation are ongoing. The concomitant use of targeted agents may produce better outcomes in the future.
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Affiliation(s)
- Fabio Ynoe de Moraes
- Hospital Sírio-Libanês, Departamento de Radioterapia, São Paulo/, SP, Brasil
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, Serviço de Radioterapia, São Paulo/SP, Brasil
- E-mail:
| | - Neil Kanth Taunk
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York/NY, USA
| | - Ilya Laufer
- Memorial Sloan Kettering Cancer Center, Department of Neurosurgery, New York/NY, USA
| | | | | | - Heloisa de Andrade Carvalho
- Hospital Sírio-Libanês, Departamento de Radioterapia, São Paulo/, SP, Brasil
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, Serviço de Radioterapia, São Paulo/SP, Brasil
| | - Yoshiya Yamada
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York/NY, USA
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Quantitative Evaluation of Local Control and Wound Healing Following Surgery and Stereotactic Spine Radiosurgery for Spine Tumors. World Neurosurg 2015; 87:48-54. [PMID: 26548834 DOI: 10.1016/j.wneu.2015.10.075] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The present study evaluated the optimal measuring criteria to assess spinal tumor response to surgery followed by stereotactic spine radiosurgery (SRS) and reports the local control and wound complication rates following combined multimodality treatment. METHODS AND MATERIALS Prospectively collected patient information was retrospectively reviewed to identify patients treated with spine surgery followed by SRS. Tumor sizes and volumetric assessment were formally measured. Local control status was defined according to World Health Organization (WHO, bidimensional), RECIST (unidimensional), or volumetric size change. Statistical comparative assessments of tumor measurements were performed. RESULTS Twenty-two patients were eligible for evaluation after having undergone surgery followed by single-fraction SRS within a 2-month period. Seventeen had follow-up magnetic resonance imaging (MRI) with a mean patient follow-up of 12.59 months (range 3-36 months). None developed wound complication after radiation therapy (95% lower confidence bound 13%). Two patients had clinical recurrence while 15 of 17 achieved local control (88.3%). A test of marginal homogeneity for RECIST versus WHO was not statistically significant, P = 1.0 suggesting similar response classifications with both systems. Spearman correlations among 1) volumetric assessment, 2) bidimensional size, and 3) unidimensional size were significant for all groups (P < 0.05). CONCLUSION High local control rates can be achieved with surgery followed by SRS. Further, adjuvant SRS following spine tumor surgery delivers less radiation to the wound than conventional radiation and thus potentially reduces wound complications. Unidimensional, bidimensional, and volumetric tumor assessments demonstrate similar results. Hence the use of the simpler RECIST criteria is suitable and appropriate for evaluating the response to treatment after spine radiosurgery.
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Redmond KJ, Sahgal A, Foote M, Knisely J, Gerszten PC, Chao ST, Suh JH, Sloan AE, Chang EL, Machtay M, Lo SS. Single versus multiple session stereotactic body radiotherapy for spinal metastasis: the risk-benefit ratio. Future Oncol 2015; 11:2405-15. [PMID: 26369361 DOI: 10.2217/fon.15.160] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Spine stereotactic body radiation therapy represents an important advancement in the management of spinal metastases that allows precise delivery of ablative doses of radiation therapy with excellent local control. Although the technique is being increasingly used in clinical practice, the optimal fractionation schedule remains uncertain. In this perspective paper, we review radiobiologic principles that support the use of multiple- versus single-fraction spine stereotactic body radiation therapy schedules and clinical data supporting the multiple-fraction approach. Specifically, we suggest that there may be a local control benefit of fractionation, while helping to limit the risk of toxicities such as vertebral body fracture, pain flare and radiation myelopathy. We conclude with future directions and the need for future study on this important topic.
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Affiliation(s)
- Kristin J Redmond
- Department of Radiation Oncology, John Hopkins University, Baltimore, MD, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Matthew Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, School of Medicine, University of Queensland, Queensland, Australia
| | - Jonathan Knisely
- Department of Radiation Medicine, North Shore - Long Island Jewish Health System, North Shore University Hospital, Manhasset, NY, USA
| | - Peter C Gerszten
- Department of Neurological Surgery & Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Samuel T Chao
- Department of Radiation Oncology, Rose Ella Burkhardt Brain Tumor & Neuro-oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - John H Suh
- Department of Radiation Oncology, Rose Ella Burkhardt Brain Tumor & Neuro-oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew E Sloan
- Departments of Neurological Surgery & Pathology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Eric L Chang
- Department of Radiation Oncology, Norris Cancer Center & Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mitchell Machtay
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Simon S Lo
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, OH, USA
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Zairi F, Vieillard MH, Assaker R. Spine metastases: are minimally invasive surgical techniques living up to the hype? CNS Oncol 2015; 4:257-64. [PMID: 26095003 DOI: 10.2217/cns.15.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Surgery is still considered the mainstay treatment of spine metastases. However, conventional surgery is associated with a high complication rate that may delay the initiation of adjuvant therapies and make some patients not eligible. Minimally invasive surgical techniques have been developed to overcome these drawbacks while providing the same benefits than standard open surgery. In recent years, there has been a flourishing enthusiasm demonstrating the advantages of these various techniques. Although, it is clear that these techniques have greatly improved the treatment of spine metastases, each has its own limitations. In this report, we list the main minimally invasive surgical techniques emphasizing their advantages and drawbacks.
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Affiliation(s)
- Fahed Zairi
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | | | - Richard Assaker
- Department of Neurosurgery, Lille University Hospital, Lille, France
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Greco C, Pares O, Pimentel N, Moser E, Louro V, Morales X, Salas B, Fuks Z. Spinal metastases: From conventional fractionated radiotherapy to single-dose SBRT. Rep Pract Oncol Radiother 2015; 20:454-63. [PMID: 26696786 DOI: 10.1016/j.rpor.2015.03.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/27/2015] [Accepted: 03/22/2015] [Indexed: 12/15/2022] Open
Abstract
AIM To review the recent evolution of spine SBRT with emphasis on single dose treatments. BACKGROUND Radiation treatment of spine metastases represents a challenging problem in clinical oncology, because of the high risk of inflicting damage to the spinal cord. While conventional fractionated radiation therapy still constitutes the most commonly used modality for palliative treatment, notwithstanding its efficacy in terms of palliation of pain, local tumor control has been approximately 60%. This limited effectiveness is due to previous lack of technology to precisely target the tumor while avoiding the radiosensitive spinal cord, which constitutes a dose-limiting barrier to tumor cure. MATERIALS AND METHODS A thorough review of the available literature on spine SBRT has been carried out and critically assessed. RESULTS Stereotactic body radiotherapy (SBRT) emerges as an alternative, non-invasive high-precision approach, which allows escalation of tumor dose, while effectively sparing adjacent uninvolved organs at risk. Engaging technological advances, such as on-line Cone Beam Computed Tomography (CBCT), coupled with Dynamic Multi-Leaf Collimation (DMLC) and rapid intensity-modulated (IMRT) beam delivery, have promoted an interactive image-guided (IGRT) approach that precisely conforms treatment onto a defined target volume with a rapid dose fall-off to collateral non-target tissues, such as the spinal cord. Recent technological developments allow the use of the high-dose per fraction mode of hypofractionated SBRT for spinal oligometastatic cancer, even if only a few millimeters away from the tumor. CONCLUSION Single-dose spine SBRT, now increasingly implemented, yields unprecedented outcomes of local tumor ablation and safety, provided that advanced technology is employed.
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Affiliation(s)
- Carlo Greco
- Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Oriol Pares
- Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Nuno Pimentel
- Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Elizabeth Moser
- Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Vasco Louro
- Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Xavier Morales
- Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Barbara Salas
- Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Zvi Fuks
- Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
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Ryu S, Yoon H, Stessin A, Gutman F, Rosiello A, Davis R. Contemporary treatment with radiosurgery for spine metastasis and spinal cord compression in 2015. Radiat Oncol J 2015; 33:1-11. [PMID: 25874172 PMCID: PMC4394063 DOI: 10.3857/roj.2015.33.1.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 12/02/2022] Open
Abstract
With the progress of image-guided localization, body immobilization system, and computerized delivery of intensity-modulated radiation delivery, it became possible to perform spine radiosurgery. The next question is how to translate the high technology treatment to the clinical application. Clinical trials have been performed to demonstrate the feasibility of spine radiosurgery and efficacy of the treatment in the setting of spine metastasis, leading to the randomized trials by a cooperative group. Radiosurgery has also demonstrated its efficacy to decompress the spinal cord compression in selected group of patients. The experience indicates that spine radiosurgery has a potential to change the clinical practice in the management of spine metastasis and spinal cord compression.
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Affiliation(s)
- Samuel Ryu
- Department of Radiation Oncology, Stony Brook University, Stony Brook, NY, USA. ; Department of Neurological Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Hannah Yoon
- Department of Radiation Oncology, Stony Brook University, Stony Brook, NY, USA
| | - Alexander Stessin
- Department of Radiation Oncology, Stony Brook University, Stony Brook, NY, USA
| | - Fred Gutman
- Department of Neurological Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Arthur Rosiello
- Department of Neurological Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Raphael Davis
- Department of Neurological Surgery, Stony Brook University, Stony Brook, NY, USA
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Anwar M, Barani IJ. Role of stereotactic body radiotherapy in spinal metastasis and subsequent fracture risk: identifying and treating the at-risk patient. CNS Oncol 2015; 2:437-45. [PMID: 25054666 DOI: 10.2217/cns.13.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The treatment of spinal metastasis has considerably improved with the advent of stereotactic body radiotherapy. Technological advances have enabled the precise delivery of high-dose radiation that may supplant surgery and standard fractionation postoperative radiation as a treatment for spinal metastasis without cord compression. Unfortunately, the higher biologically equivalent doses conferred by stereotactic body radiotherapy can also result in radiation toxicity, notably myelitis and vertebral body fracture. These are toxicities that the radiation oncologist must be able to anticipate, mitigate and manage. Although myelitis can be prevented largely by instituting dose constraints, it is less clear what the fracture risk of a structurally compromised vertebra is, and what should be done in terms of stabilization and dosimetry to mitigate this risk. This review answers these questions by defining the appropriate patient for stereotactic body radiotherapy, and what dose, fractionation and spinal stabilization should be used for potentially unstable spines.
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Affiliation(s)
- Mekhail Anwar
- University of California, San Francisco, Department of Radiation Oncology, Room L-08, Box 0226, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA
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Kim H, Rajagopalan MS, Beriwal S, Huq MS, Smith KJ. Cost-effectiveness analysis of single fraction of stereotactic body radiation therapy compared with single fraction of external beam radiation therapy for palliation of vertebral bone metastases. Int J Radiat Oncol Biol Phys 2015; 91:556-63. [PMID: 25680599 DOI: 10.1016/j.ijrobp.2014.10.055] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/16/2014] [Accepted: 10/28/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) has been proposed for the palliation of painful vertebral bone metastases because higher radiation doses may result in superior and more durable pain control. A phase III clinical trial (Radiation Therapy Oncology Group 0631) comparing single fraction SBRT with single fraction external beam radiation therapy (EBRT) in palliative treatment of painful vertebral bone metastases is now ongoing. We performed a cost-effectiveness analysis to compare these strategies. METHODS AND MATERIALS A Markov model, using a 1-month cycle over a lifetime horizon, was developed to compare the cost-effectiveness of SBRT (16 or 18 Gy in 1 fraction) with that of 8 Gy in 1 fraction of EBRT. Transition probabilities, quality of life utilities, and costs associated with SBRT and EBRT were captured in the model. Costs were based on Medicare reimbursement in 2014. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and effectiveness was measured in quality-adjusted life years (QALYs). To account for uncertainty, 1-way, 2-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay (WTP) threshold of $100,000 per QALY gained. RESULTS Base case pain relief after the treatment was assumed as 20% higher in SBRT. Base case treatment costs for SBRT and EBRT were $9000 and $1087, respectively. In the base case analysis, SBRT resulted in an ICER of $124,552 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of the utility of unrelieved pain; the utility of relieved pain after initial treatment and median survival were also sensitive to variation. If median survival is ≥11 months, SBRT cost <$100,000 per QALY gained. CONCLUSION SBRT for palliation of vertebral bone metastases is not cost-effective compared with EBRT at a $100,000 per QALY gained WTP threshold. However, if median survival is ≥11 months, SBRT costs ≤$100,000 per QALY gained, suggesting that selective SBRT use in patients with longer expected survival may be the most cost-effective approach.
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Affiliation(s)
- Hayeon Kim
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
| | - Malolan S Rajagopalan
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - M Saiful Huq
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Kenneth J Smith
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Radiothérapie stéréotaxique hypofractionnée des métastases osseuses. Cancer Radiother 2014; 18:342-9. [DOI: 10.1016/j.canrad.2014.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/14/2014] [Accepted: 04/29/2014] [Indexed: 11/21/2022]
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Itshayek E, Cohen JE, Yamada Y, Gokaslan Z, Polly DW, Rhines LD, Schmidt MH, Varga PP, Mahgarefteh S, Fraifeld S, Gerszten PC, Fisher CG. Timing of stereotactic radiosurgery and surgery and wound healing in patients with spinal tumors: a systematic review and expert opinions. Neurol Res 2014; 36:510-23. [DOI: 10.1179/1743132814y.0000000380] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lo SS, Fakiris AJ, Teh BS, Cardenes HR, Henderson MA, Forquer JA, Papiez L, McGarry RC, Wang JZ, Li K, Mayr NA, Timmerman RD. Stereotactic body radiation therapy for oligometastases. Expert Rev Anticancer Ther 2014; 9:621-35. [DOI: 10.1586/era.09.15] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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47
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Lo SS, Cardenes HR, Teh BS, Fakiris AJ, Henderson MA, Papiez L, McGarry RC, Wang JZ, Li K, Mayr NA, Timmerman RD. Stereotactic body radiation therapy for nonpulmonary primary tumors. Expert Rev Anticancer Ther 2014; 8:1939-51. [DOI: 10.1586/14737140.8.12.1939] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lo SS, Chang EL, Yamada Y, Sloan AE, Suh JH, Mendel E. Stereotactic radiosurgery and radiation therapy for spinal tumors. Expert Rev Neurother 2014; 7:85-93. [PMID: 17187488 DOI: 10.1586/14737175.7.1.85] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Spinal tumors constitute 15% of all CNS neoplasms. Radiation therapy can be administered for palliation of pain and spinal cord compression. However, the amount of radiation that can be administered is often limited by the tolerance of the spinal cord, especially in cases where prior radiation therapy has been given. Stereotactic radiosurgery and radiotherapy allow the delivery of a higher dose of radiation to spinal lesions, while limiting the spinal cord dose to below the tolerance level. These are technically demanding procedures and should be performed only when proper equipment and expertise are available. Data on spinal stereotactic radiosurgery and radiotherapy have emerged in recent years. This review summarizes the clinical applications of stereotactic radiosurgery and radiotherapy for spinal tumors.
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Affiliation(s)
- Simon S Lo
- Department of Radiation Medicine, Ohio State University Medical Center, Columbus, OH 43210, USA.
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Kirkpatrick JP, Kelsey CR, Palta M, Cabrera AR, Salama JK, Patel P, Perez BA, Lee J, Yin FF. Stereotactic body radiotherapy: a critical review for nonradiation oncologists. Cancer 2013; 120:942-54. [PMID: 24382744 DOI: 10.1002/cncr.28515] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/11/2013] [Accepted: 11/12/2013] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiotherapy (SBRT) involves the treatment of extracranial primary tumors or metastases with a few, high doses of ionizing radiation. In SBRT, tumor kill is maximized and dose to surrounding tissue is minimized, by precise and accurate delivery of multiple radiation beams to the target. This is particularly challenging, because extracranial lesions often move with respiration and are irregular in shape, requiring careful treatment planning and continual management of this motion and patient position during irradiation. This review presents the rationale, process workflow, and technology for the safe and effective administration of SBRT, as well as the indications, outcome, and limitations for this technique in the treatment of lung cancer, liver cancer, and metastatic disease.
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Affiliation(s)
- John P Kirkpatrick
- Department of Radiation Oncology, Duke Cancer Institute, and the Durham VA Medical Center, Durham, North Carolina
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Kaloostian PE, Yurter A, Zadnik PL, Sciubba DM, Gokaslan ZL. Current paradigms for metastatic spinal disease: an evidence-based review. Ann Surg Oncol 2013; 21:248-62. [PMID: 24145995 DOI: 10.1245/s10434-013-3324-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Management of metastatic spine disease is quite complex. Advances in research have allowed surgeons and physicians to better provide chemotherapeutic agents that have proven more efficacious. Additionally, the advancement of surgical techniques and radiosurgical implementation has altered drastically the treatment paradigm for metastatic spinal disease. Nevertheless, the physician-patient relationship, including extensive discussion with the neurosurgeon, medicine team, oncologists, radiation oncologists, and psychologists, are all critical in the evaluation process and in delivering the best possible care to our patients. The future remains bright for continued improvement in the surgical and nonsurgical management of our patients with metastatic spine disease. METHODS We include an evidence-based review of decision making strategies when attempting to determine most efficacious treatment options. Surgical treatments discussed include conventional debulking versus en bloc resection, conventional RT, and radiosurgical techniques, and minimally invasive approaches toward treating metastatic spinal disease. CONCLUSIONS Surgical oncology is a diverse field in medicine and has undergone a significant paradigm shift over the past few decades. This shift in both medical and surgical management of patients with primarily metastatic tumors has largely been due to the more complete understanding of tumor biology as well as due to advances in surgical approaches and instrumentation. Furthermore, radiation oncology has seen significant advances with stereotactic radiosurgery and intensity-modulated radiation therapy contributing to a decline in surgical treatment of metastatic spinal disease. We analyze the entire spectrum of treating patients with metastatic spinal disease, from methods of diagnosis to the variety of treatment options available in the published literature.
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Affiliation(s)
- P E Kaloostian
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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