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Amraee A, Tohidkia MR, Darvish L, Tarighatnia A, Robatmili N, Rahimi A, Rezaei N, Ansari F, Teshnizi SH, Aghanejad A. Spinal Reirradiation-Mediated Myelopathy: A Systematic Review and Meta-Analysis. Clin Oncol (R Coll Radiol) 2023; 35:576-585. [PMID: 37301719 DOI: 10.1016/j.clon.2023.05.017] [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: 10/20/2022] [Revised: 05/12/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
Reirradiation of the spine is carried out in 42% of patients who do not respond to treatment or have recurrent pain. However, there are few studies and data on the effect of reirradiation of the spine and the occurrence of acute and chronic side-effects caused by reirradiation, such as myelopathy, in these patients. This meta-analysis aimed to determine the safe dose in terms of biological effective dose (BED), cumulative dose and dose interval between BED1 and BED2 to decrease or prevent myelopathy and pain control in patients undergoing radiation therapy in the spinal cord. A search was carried out using EMBASE, MEDLINE, PUBMED, Google Scholar, Cochrane Collaboration library electronic databases, Magiran, and SID from 2000 to 2022 to recognise qualified studies. In total, 17 primary studies were applied to estimate the pooled effect size. The random effects model showed that the pooled BED in the first stage, the BED in the second stage and the cumulative BED1 and BED2 were estimated at 77.63, 58.35 and 115.34 Gy, respectively. Studies reported on dose interval. The results of a random effects model showed that the pooled interval was estimated at 13.86 months. The meta-analysis revealed that using appropriate BED1 and/or BED2 in a safe interval between the first and second phases of treatment can have an influential role in preventing or reducing the effects of myelopathy and regional control pain in spinal reirradiation.
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Affiliation(s)
- A Amraee
- Research Center for Pharmaceutical Nanotechnology, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Medical Physics, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - M R Tohidkia
- Research Center for Pharmaceutical Nanotechnology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - L Darvish
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - A Tarighatnia
- Department of Medical Physics, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - N Robatmili
- Department of Radiotherapy, Sina Hospital, Arak, Iran; Department of Medical Physics, School of Medicine, Kashan University of Medical Sciences, Tehran, Iran
| | - A Rahimi
- Department of Medical Physics, School of Medicine, Kashan University of Medical Sciences, Tehran, Iran
| | - N Rezaei
- Department of Medical Physics, School of Medicine, Kashan University of Medical Sciences, Tehran, Iran
| | - F Ansari
- Department of Radiation Sciences, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran; Nursing and Midwifery School, Hormozgan University of Medical Sciences, Bandar-abbas, Iran
| | - S H Teshnizi
- Nursing and Midwifery School, Hormozgan University of Medical Sciences, Bandar-abbas, Iran
| | - A Aghanejad
- Research Center for Pharmaceutical Nanotechnology, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Nuclear Medicine, Faculty of Medicine, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
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Soltys SG, Grimm J, Milano MT, Xue J, Sahgal A, Yorke E, Yamada Y, Ding GX, Li XA, Lovelock DM, Jackson A, Ma L, El Naqa I, Gibbs IC, Marks LB, Benedict S. Stereotactic Body Radiation Therapy for Spinal Metastases: Tumor Control Probability Analyses and Recommended Reporting Standards. Int J Radiat Oncol Biol Phys 2021; 110:112-123. [PMID: 33516580 DOI: 10.1016/j.ijrobp.2020.11.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE We sought to investigate the tumor control probability (TCP) of spinal metastases treated with stereotactic body radiation therapy (SBRT) in 1 to 5 fractions. METHODS AND MATERIALS PubMed-indexed articles from 1995 to 2018 were eligible for data extraction if they contained SBRT dosimetric details correlated with actuarial 2-year local tumor control rates. Logistic dose-response models of collected data were compared in terms of physical dose and 3-fraction equivalent dose. RESULTS Data were extracted from 24 articles with 2619 spinal metastases. Physical dose TCP modeling of 2-year local tumor control from the single-fraction data were compared with data from 2 to 5 fractions, resulting in an estimated α/β = 6 Gy, and this was used to pool data. Acknowledging the uncertainty intrinsic to the data extraction and modeling process, the 90% TCP corresponded to 20 Gy in 1 fraction, 28 Gy in 2 fractions, 33 Gy in 3 fractions, and (with extrapolation) 40 Gy in 5 fractions. The estimated TCP for common fractionation schemes was 82% at 18 Gy, 90% for 20 Gy, and 96% for 24 Gy in a single fraction, 82% for 24 Gy in 2 fractions, and 78% for 27 Gy in 3 fractions. CONCLUSIONS Spinal SBRT with the most common fractionation schemes yields 2-year estimates of local control of 82% to 96%. Given the heterogeneity in the tumor control estimates extracted from the literature, with variability in reporting of dosimetry data and the definition of and statistical methods of reporting tumor control, care should be taken interpreting the resultant model-based estimates. Depending on the clinical intent, the improved TCP with higher dose regimens should be weighed against the potential risks for greater toxicity. We encourage future reports to provide full dosimetric data correlated with tumor local control to allow future efforts of modeling pooled data.
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Affiliation(s)
- Scott G Soltys
- Department of Radiation Oncology, Stanford University, Stanford, California.
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania; Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Jinyu Xue
- Department of Radiation Oncology, NYU Langone Medical Center, New York, New York
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - George X Ding
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - D Michael Lovelock
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Lijun Ma
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Issam El Naqa
- Machine Learning Department, Moffitt Cancer Center, Tampa, Florida
| | - Iris C Gibbs
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina, Lineberger Cancer Center, Chapel Hill, North Carolina
| | - Stanley Benedict
- Department of Radiation Oncology, University of California at Davis, Sacramento, California
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Cao X, Fang L, Cui CY, Gao S, Wang TW. DTI and pathological changes in a rabbit model of radiation injury to the spinal cord after 125I radioactive seed implantation. Neural Regen Res 2018; 13:528-535. [PMID: 29623940 PMCID: PMC5900518 DOI: 10.4103/1673-5374.228758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Excessive radiation exposure may lead to edema of the spinal cord and deterioration of the nervous system. Magnetic resonance imaging can be used to judge and assess the extent of edema and to evaluate pathological changes and thus may be used for the evaluation of spinal cord injuries caused by radiation therapy. Radioactive 125I seeds to irradiate 90% of the spinal cord tissue at doses of 40–100 Gy (D90) were implanted in rabbits at T10 to induce radiation injury, and we evaluated their safety for use in the spinal cord. Diffusion tensor imaging showed that with increased D90, the apparent diffusion coefficient and fractional anisotropy values were increased. Moreover, pathological damage of neurons and microvessels in the gray matter and white matter was aggravated. At 2 months after implantation, obvious pathological injury was visible in the spinal cords of each group. Magnetic resonance diffusion tensor imaging revealed the radiation injury to the spinal cord, and we quantified the degree of spinal cord injury through apparent diffusion coefficient and fractional anisotropy.
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Affiliation(s)
- Xia Cao
- School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin Province, China
| | - Le Fang
- First Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Chuan-Yu Cui
- Department of MRI, Fourth Hospital, Jilin University, Changchun, Jilin Province, China
| | - Shi Gao
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Tian-Wei Wang
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
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CT-Guided 125I Seed Interstitial Brachytherapy as a Salvage Treatment for Recurrent Spinal Metastases after External Beam Radiotherapy. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8265907. [PMID: 28105434 PMCID: PMC5220449 DOI: 10.1155/2016/8265907] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 10/30/2016] [Accepted: 11/29/2016] [Indexed: 11/17/2022]
Abstract
The aim of this study is to evaluate the feasibility, safety, and clinical efficacy of CT-guided 125I seed interstitial brachytherapy in patients with recurrent spinal metastases after external beam radiotherapy (EBRT). Between August 2003 and September 2015, 26 spinal metastatic lesions (24 patients) were reirradiated by this salvage therapy modality. Treatment for all patients was preplanned using a three-dimensional treatment planning system 3-5 days before 125I seed interstitial brachytherapy; dosimetry verification was performed immediately after seed implantation. Median actual D90 was 99 Gy (range, 90-176), and spinal cord median Dmax was 39 Gy (range, 6-110). Median local control (LC) was 12 months (95% CI: 7.0-17.0). The 6- and 12-month LC rates were 52% and 40%, respectively. Median overall survival (OS) was 11 months (95% CI: 7.7-14.3); 6-month and 1-, 2-, and 3-year OS rates were 65%, 37%, 14%, and 9%, respectively. Pain-free survival ranged from 2 to 42 months (median, 6; 95% CI: 4.6-7.4). Treatment was well-tolerated, with no radiation-induced vertebral compression fractures or myelopathy reported. Reirradiation with CT-guided 125I seed interstitial brachytherapy appears to be feasible, safe, and effective as pain relief or salvage treatment for patients with recurrent spinal metastases after EBRT.
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Kawashiro S, Harada H, Katagiri H, Asakura H, Ogawa H, Onoe T, Sumita K, Murayama S, Murata H, Nemoto K, Takahashi M, Nishimura T. Reirradiation of spinal metastases with intensity-modulated radiation therapy: an analysis of 23 patients. JOURNAL OF RADIATION RESEARCH 2016; 57:150-156. [PMID: 26662113 PMCID: PMC4795950 DOI: 10.1093/jrr/rrv083] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/01/2015] [Accepted: 10/09/2015] [Indexed: 06/05/2023]
Abstract
This study aimed to evaluate the efficacy and safety of reirradiation with intensity-modulated radiation therapy (IMRT) for spinal metastases. We retrospectively analyzed 23 patients with spinal metastases who underwent IMRT reirradiation between December 2006 and July 2013. We evaluated the spinal radiation doses during the first and second radiation therapy courses, the interval between the courses, and the clinical outcomes after reirradiation, including skeletal-related events, local control rates (LCRs), overall survival (OS), and toxicities. The median time from the first irradiation to reirradiation was 13 months (range, 2-75 months). The median reirradiation dose delivered to 90% of the planning target volume was 24.5 Gy in 5 fractions (range, 14.7-50 Gy in 3-25 fractions). Nineteen patients experienced pain at reirradiation, and 15 of these attained pain relief. Two of the three patients with paresis in the upper or lower extremities upon initiation of reirradiation demonstrated improvement. Local progression was identified in four patients. The median time to local progression was 37 months. The 1- and 2-year LCRs after reirradiation were 88% and 75%, respectively. The 1- and 2-year OS rates after reirradiation were 45% and 20%, respectively, with a median OS of 12 months. No late toxicities occurred. In conclusion, spinal metastasis reirradiation using IMRT appears safe; pain relief and paresis improvement and/or prevention can be expected, along with a reduced risk of radiation-induced toxicity, especially in the spinal cord.
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Affiliation(s)
- Shohei Kawashiro
- Division of Radiation Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Shizuoka 411-8777, Japan Department of Radiation Oncology, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Hideyuki Harada
- Division of Radiation Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Shizuoka 411-8777, Japan
| | - Hirohisa Katagiri
- Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Shizuoka 411-8777, Japan
| | - Hirofumi Asakura
- Division of Radiation Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Shizuoka 411-8777, Japan
| | - Hirofumi Ogawa
- Division of Radiation Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Shizuoka 411-8777, Japan
| | - Tsuyoshi Onoe
- Division of Radiation Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Shizuoka 411-8777, Japan
| | - Kiyomi Sumita
- Division of Radiation Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Shizuoka 411-8777, Japan
| | - Shigeyuki Murayama
- Division of Proton Therapy, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Shizuoka 411-8777, Japan
| | - Hideki Murata
- Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Shizuoka 411-8777, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Mitsuru Takahashi
- Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Shizuoka 411-8777, Japan
| | - Tetsuo Nishimura
- Division of Radiation Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Shizuoka 411-8777, Japan
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Zohrabian VM, Husain ZA, Laurans MS, Chiang VL, Mahajan A, Johnson MH. Practice Building: Achieving Growth Through Computed Tomographic Myelography-Based Stereotactic Body Radiation Therapy for Spinal Metastases. Curr Probl Diagn Radiol 2016; 45:324-9. [PMID: 26920633 DOI: 10.1067/j.cpradiol.2016.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/26/2016] [Indexed: 11/22/2022]
Abstract
Stereotactic body radiation therapy (SBRT) is as an effective method to treat spinal metastases. Imaging is a critical component in the workup of patients who undergo stereotactic radiation treatment. Computed tomographic myelography may be more accurate than magnetic resonance imaging in the delineation of neural elements during SBRT. The task we faced was to offer a standardized method to rapidly and safely obtain high-quality computed tomographic myelography as part of a robust spine SBRT program. In detailing our experience, we support the greater, active participation of radiologists in the multidisciplinary care of patients with spinal metastases, while encouraging other radiologists to foster similar collaborations at their own institutions.
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Affiliation(s)
- Vahe M Zohrabian
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT.
| | - Zain A Husain
- Department of Therapeutic Radiology/Radiation Oncology, Yale School of Medicine, New Haven, CT
| | | | - Veronica L Chiang
- Department of Therapeutic Radiology/Radiation Oncology, Yale School of Medicine, New Haven, CT; Department of Neurosurgery, Yale School of Medicine, New Haven, CT
| | - Amit Mahajan
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT
| | - Michele H Johnson
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT; Department of Neurosurgery, Yale School of Medicine, New Haven, CT
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Jain AK, Yamada YJ. The role of stereotactic body radiotherapy and stereotactic radiosurgery in the re-irradiation of metastatic spinal tumors. Expert Rev Anticancer Ther 2014; 14:1141-52. [PMID: 25066490 DOI: 10.1586/14737140.2014.940326] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS) are advanced radiotherapy delivery techniques that allow for the delivery of high-dose per fraction radiation. Advances in imaging technology and intensity modulation have allowed SRS and SBRT to be used for the treatment of tumors in close proximity to the spinal cord and cauda equina, in particular spinal metastases. While the initial treatment of spinal metastases is often conventional palliative radiotherapy, treatment failure is not uncommon, and conventional re-irradiation may not be feasible due to spinal cord tolerance. SBRT and SRS have emerged as important techniques for the treatment of spinal metastases in the proximity of previously irradiated spinal cord. Here we review the current data on the use of SBRT and SRS spinal re-irradiation, and future directions for these important treatment modalities.
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Affiliation(s)
- Anshu K Jain
- Department of Radiation Oncology, Columbia University Medical Center and New York Presbyterian Hospital, 622 W. 168th St, New York, NY 10032, USA
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Navarria P, Mancosu P, Alongi F, Pentimalli S, Tozzi A, Reggiori G, Ascolese AM, Arcangeli S, Lobefalo F, Baena RRY, Castiglioni S, Pessina F, Tancioni F, Santoro A, Fogliata A, Cozzi L, Scorsetti M. Vertebral metastases reirradiation with volumetric-modulated arc radiotherapy. Radiother Oncol 2012; 102:416-20. [DOI: 10.1016/j.radonc.2011.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 09/28/2011] [Accepted: 11/06/2011] [Indexed: 10/14/2022]
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Haddad H, Dejean C, Henriques de Figueiredo B, Sargos P, Caron J, Stoeckle E, Bui BN, Italiano A, Gille O, Kantor G. Expérience de l’institut Bergonié à propos de 14 cas de tomothérapie hélicoïdale de tumeurs axiales et para-axiales. Cancer Radiother 2011; 15:404-12. [DOI: 10.1016/j.canrad.2011.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 03/03/2011] [Accepted: 03/07/2011] [Indexed: 11/25/2022]
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Samant R, Gerig L, Montgomery L, Macrae R, Fox G, Nyiri B, Carty K, Macpherson M. The emerging role of IG-IMRT for palliative radiotherapy: a single-institution experience. ACTA ACUST UNITED AC 2011; 16:40-5. [PMID: 19526084 PMCID: PMC2695710 DOI: 10.3747/co.v16i3.304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Many modern radiotherapy centers now have image-guided intensity-modulated radiotherapy (ig-imrt) tools available for clinical use, and the technique offers many options for patients requiring palliative radiotherapy. We describe a single-institution experience with ig-imrt for short-course palliative radiotherapy, highlighting the unique situations in which the technique can be most effectively used.
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Affiliation(s)
- R Samant
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre and University of Ottawa, ON.
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Murino P, Mammucari M, Borrelli D, Pepe A, Giugliano MF, Morra A, Panelli G, Manzo R, Ravo V, Muto P. Role of Immediate-Release Morphine (MIR) in the Treatment of Predictable Pain in Radiotherapy. J Pain Palliat Care Pharmacother 2011; 25:121-4. [DOI: 10.3109/15360288.2011.554488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Joseph K, Tai P, Wu J, Barnes E, Levin W. Workshop report: A practical approach and general principles of re-irradiation for in-field cancer recurrence. Clin Oncol (R Coll Radiol) 2011; 22:885-9. [PMID: 20888198 DOI: 10.1016/j.clon.2010.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 06/03/2010] [Accepted: 08/18/2010] [Indexed: 01/18/2023]
Abstract
In-field cancer recurrence after previous adjuvant or radical radiotherapy presents particularly challenging clinical issues to the oncologists. A Canadian pattern of practice survey showed a wide range of approaches in treatment intent, planning and dose fractionation. A workshop on re-irradiation was conducted at the 2009 Canadian Association of Radiation Oncology annual scientific meeting, under the guidance of the Symptom Control Committee, in an effort to promote a uniform approach among radiation oncologists in their approach to re-irradiation. The workshop has made various recommendations in an effort to bring consistency among radiation oncologists across Canada to their approach towards re-irradiation.
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Affiliation(s)
- K Joseph
- Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, AB, Canada.
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Damast S, Wright J, Bilsky M, Hsu M, Zhang Z, Lovelock M, Cox B, Zatcky J, Yamada Y. Impact of dose on local failure rates after image-guided reirradiation of recurrent paraspinal metastases. Int J Radiat Oncol Biol Phys 2010; 81:819-26. [PMID: 20888133 DOI: 10.1016/j.ijrobp.2010.06.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 05/28/2010] [Accepted: 06/11/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE To examine the impact of dose on local failure (LF) rates in the re-treatment of recurrent paraspinal metastases with image-guided intensity-modulated radiotherapy (IG-IMRT). METHODS AND MATERIALS The records of patients with in-field recurrence after previous spine radiation (median dose, 30 Gy) who received salvage IG-IMRT with either five 4-Gy (20-Gy group, n = 42) or five 6-Gy (30-Gy group, n = 55) daily fractions between January 2003 and August 2008 were reviewed. Institutional practice was 20 Gy before April 2006, when it changed to 30 Gy. A total of 47 cases (48%) were treated adjuvantly, after surgery to decompress epidural disease. LF after IG-IMRT was defined radiographically. RESULTS The median follow-up was 12.1 months (range, 0.2-63.6 months). The 1-year cumulative incidences of LF after 20 Gy and 30 Gy IG-IMRT were 45% and 26%, respectively (p = 0.04). Of all treatment characteristics examined (20-Gy vs. 30-Gy dose group, dose to 95% of the planned and gross target volume, tumor size, histology, receipt of surgery, and interval between first and second radiation), only dose group had a significant impact on actuarial LF incidence (p = 0.04; unadjusted HR, 0.51; 95% CI, 0.27-0.96). There was no incidence of myelopathy. CONCLUSIONS A significant decrease in LF after IG-IMRT with five 6-Gy fractions compared with five 4-Gy fractions was observed without increased risk of myelopathy. Until prospective data comparing stereotactic hypofractionated and single-fraction regimens become available, when reirradiating recurrent paraspinal metastases with IG-IMRT, administration of five 6-Gy daily fractions is reasonable.
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Affiliation(s)
- Shari Damast
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Rapid palliative radiotherapy: comparing IG-IMRT with more conventional approaches. JOURNAL OF RADIOTHERAPY IN PRACTICE 2010. [DOI: 10.1017/s1460396909990379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractPurpose: To assess the efficiency of an integrated imaging, planning, and treatment delivery system to provide image-guided intensity-modulated radiotherapy (IG-IMRT) for patients requiring palliative radiotherapy (PRT).Methods: Between December 2006 and May 2008, 28 patients requiring urgent PRT were selected to undergo single-session megavoltage computed tomography (MV-CT) simulation, IMRT treatment planning, position verification and delivery of the first faction of radiotherapy on a helical Tomotherapy® unit. The time required to complete each step was recorded and compared to our standard approach of using either fluoroscopic or CT-based simulation, simplified treatment planning and delivery on a megavoltage unit.Results: Twenty-eight patients were treated with our integrated IG-IMRT protocol. The median age was 72 years, with 61% men and 39% women. The indications for PRT were: painful bone and soft tissue metastasis (75%); bleeding lesions (14%); and other reasons (11%). The areas treated included the following: hip and/or pelvis (42%); spine (36%); and other areas (21%). The most commonly used dose prescription was 20 Gy in five fractions. Average times for the integrated IG-IMRT processes were as follows: image acquisition, 15 minutes; target delineation, 16 minutes; IMRT treatment planning, 9 minutes; treatment position verification, 10 minutes; and treatment delivery, 12 minutes. The average total time was 62 minutes compared to 66 minutes and 81 minutes for fluoroscopic and CT-simulation-based approaches, respectively. The IMRT dose distributions were also superior to simpler plans.Conclusions: PRT with an integrated IG-IMRT approach is efficient and convenient for patients, and has potential for future applications such as single-fraction radiotherapy.
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15
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Sterzing F, Hauswald H, Uhl M, Herm H, Wiener A, Herfarth K, Debus J, Krempien R. Spinal cord sparing reirradiation with helical tomotherapy. Cancer 2010; 116:3961-3968. [DOI: 10.1002/cncr.25187] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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16
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Kirkpatrick JP, van der Kogel AJ, Schultheiss TE. Radiation Dose–Volume Effects in the Spinal Cord. Int J Radiat Oncol Biol Phys 2010; 76:S42-9. [PMID: 20171517 DOI: 10.1016/j.ijrobp.2009.04.095] [Citation(s) in RCA: 322] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 04/17/2009] [Accepted: 04/22/2009] [Indexed: 12/22/2022]
Affiliation(s)
- John P Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
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Gomez DR, Hunt MA, Jackson A, O'Meara WP, Bukanova EN, Zelefsky MJ, Yamada Y, Rosenzweig KE. Low rate of thoracic toxicity in palliative paraspinal single-fraction stereotactic body radiation therapy. Radiother Oncol 2009; 93:414-8. [PMID: 19923027 DOI: 10.1016/j.radonc.2009.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 09/29/2009] [Accepted: 10/11/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND There has been an increase in the utilization of single-fraction stereotactic body radiation therapy (SBRT) to treat thoracic structures, but there have been few reports describing toxicity outcomes with this treatment. METHODS We evaluated 119 sites (114 patients) with no prior history of thoracic radiation were treated from 10/1/2003 to 10/27/2008 with single-fraction SBRT to thoracic structures. The median dose to the gross tumor volume was 2400 cGy (range 1800-2400 cGy), as was the median dose to the planning target volume (range 1600-2400 cGy). A detailed review of thoracic toxicities was performed to include pneumonitis or Grade 2 or higher esophageal and bronchial toxicity. In addition, we retrospectively contoured the esophagus and bronchus of 48 patients treated in 2004-2005, prior to the establishment of dose constraints to determine the range of doses that these structures received. RESULTS Of the contoured patients, the median dose to the hottest 1cc (D1cc) of the esophagus was 1250 cGy (range 158-2572 cGy). The median bronchial D1cc was 1101 cGy (range 260-2211 cGy). At a median follow-up of 11.6 months, there were seven Grade 2 or higher esophageal toxicities, including one Grade 3 and one Grade 4 toxicities. There were two bronchial toxicities, one Grade 2 and one Grade 3. There were no cases of pneumonitis. CONCLUSIONS High-dose single-fraction SBRT is well tolerated to the thoracic region, with most patients tolerating high doses to central structures without significant toxicity.
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Affiliation(s)
- Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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A Prospective, Phase II Study Demonstrating the Potential Value and Limitation of Radiosurgery for Spine Metastases. Am J Clin Oncol 2009; 32:515-20. [DOI: 10.1097/coc.0b013e318194f70f] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sahgal A, Larson DA, Chang EL. Stereotactic body radiosurgery for spinal metastases: a critical review. Int J Radiat Oncol Biol Phys 2008; 71:652-65. [PMID: 18514775 DOI: 10.1016/j.ijrobp.2008.02.060] [Citation(s) in RCA: 210] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 02/06/2008] [Accepted: 02/13/2008] [Indexed: 12/13/2022]
Affiliation(s)
- Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
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Yamada Y, Lovelock DM, Bilsky MH. A REVIEW OF IMAGE-GUIDED INTENSITY-MODULATED RADIOTHERAPY FOR SPINAL TUMORS. Neurosurgery 2007; 61:226-35; discussion 235. [PMID: 17762734 DOI: 10.1227/01.neu.0000279970.10309.b5] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
OBJECTIVE
A new paradigm for the radiotherapeutic management of paraspinal tumors has emerged. Intensity-modulated radiotherapy (IMRT) has gained wide acceptance as a way of delivering highly conformal radiation to tumors. IMRT is capable of sparing sensitive structures such as the spinal cord of high-dose radiation even if only several millimeters away from the tumor. Image-guided treatment tools such as cone beam computed tomography coupled with IMRT have reduced treatment errors associated with traditional radiotherapy, making highly accurate and conformal treatment feasible.
METHODS
This review discusses the physics of image-guided radiotherapy, including immobilization, the radiobiological implications of hypofractionation, as well as outcomes. Image-guided technology has improved the accuracy of IMRT to within 2 mm of error. Thus, the marriage of image guidance with IMRT (IG IMRT) has allowed the safe treatment of spinal tumors to a high dose without increasing the risk of radiation-related toxicity. With the use of near real-time image-guided verification, very-high-dose radiation has been given for tumors in standard fractionation, hypofractionated, and single fraction schedules to doses beyond levels traditionally believed safe in terms of spinal cord tolerance.
RESULTS
Clinical results, in terms of treatment-related toxicity and tumor control, have been very favorable. With follow-up periods extending beyond 30 months, tumor control rates with single fraction IG IMRT (1800–2400 cGy) are in excess of 90%, regardless of histology, and without serious sequelae such as radiation myelopathy. Patients also report correspondingly high rates of palliation. Excellent results, both in terms of tumor control and minimal toxicity, have been consistently reported in the literature.
CONCLUSION
IG IMRT represents a significant technological advance. Paraspinal IG IMRT is proof of principle, making it possible to give very-high-dose radiation within close proximity to the spinal cord. By reducing treatment-related uncertainties, margins around tumors can be shortened, thereby reducing the volume of normal tissue that must be irradiated to tumoricidal doses, reducing the likelihood of toxicity. Similarly, higher doses of radiation can be administered safely, improving the likelihood of eradication. Dose escalation can be done to increase the likelihood of tumor cell kill without increasing the dose given to nearby sensitive structures.
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Affiliation(s)
- Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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