Native failure and vertebral physique fracture threat utilizing multifraction stereotactic physique radiation remedy for backbone metastases.
Adv Radiat Oncol. 2018 Jul-Sep;three(three):245-251
Authors: Mehta N, Zavitsanos PJ, Moldovan Ok, Oyelese A, Fridley JS, Gokaslan Z, Kinsella TJ, Hepel JT
Objective: Single-fraction radiation surgical procedure for backbone metastases is extremely efficient. Nonetheless, a excessive fee (20-39%) of vertebral physique fracture (VBF) has been related to giant, single-fraction doses. We report our expertise utilizing multifraction stereotactic physique radiation remedy (SBRT).
Strategies and supplies: All sufferers who have been handled with multifraction SBRT for backbone metastases at our establishment between 2009 and 2017 have been retrospectively analyzed. SBRT was delivered in 2 to five fractions utilizing the Cyberknife System (Accuray, Sunnyvale, CA). Sufferers have been adopted clinically and with magnetic resonance imaging each three to six months. Native management, issues (together with VBF), and general survival have been evaluated. Affected person, illness, and therapy variables have been analyzed for a statistical affiliation with outcomes.
Outcomes: A complete of 83 sufferers have been handled to 98 backbone lesions with a median follow-up of seven.6 months. Histologies included non-small cell lung most cancers (NSCLC; 24%), renal cell carcinoma (RCC; 18%), and breast most cancers (12%). Surgical procedure or vertebroplasty have been carried out earlier than SBRT in 21% of instances. Sufferers acquired a median SBRT dose of 24?Gy in a median of three fractions. Native management was 93% at 6 months and 84% at 1 yr. Greater prescribed dose, larger biologic efficient dose, larger minimal dose to 90% of the planning goal quantity, tumor histology, and smaller tumor quantity predicted improved native management. The cumulative dose was 23?Gy versus 26?Gy for sufferers with and with out failure (P?=?.02), larger biologic efficient dose 39?Gy versus 46?Gy, (P?=?.01), and better minimal dose to 90% of the planning goal quantity 23?Gy versus 26?Gy (P?=?.03). VBF occurred in four.2% of all instances and 5.three% of these with out surgical procedure or vertebroplasty previous to SBRT. Solely preexisting VBF predicted threat of post-SBRT VBF (P?<?.01).
Conclusions: Multifraction SBRT leads to a excessive native management fee for metastatic spinal illness with a low VBF fee, which suggests a good therapeutic ratio in contrast with single-fraction SBRT.
PMID: 30202794 [PubMed]