Stereotactic physique radiation remedy for benign backbone tumors: is dose de-escalation applicable?
J Neurosurg Backbone. 2018 Might 25;:1-6
Authors: Kalash R, Glaser SM, Flickinger JC, Burton S, Heron DE, Gerszten PC, Engh JA, Amankulor NM, Vargo JA
OBJECTIVE Akin to the nonoperative administration of benign intracranial tumors, stereotactic physique radiation remedy (SBRT) has emerged as a nonoperative therapy possibility for noninfiltrative major backbone tumors resembling meningioma and schwannoma. Nearly all of preliminary sequence used greater doses of 16-24 Gy in 1-Three fractions. The authors hypothesized that decrease doses (resembling 12-13 Gy in 1 fraction) may present an efficacy just like that discovered with the dose de-escalation generally used for intracranial radiosurgery to deal with acoustic neuroma or meningioma and with a decrease danger of toxicity. METHODS The authors recognized 38 sufferers in a prospectively maintained institutional radiosurgery database who had been handled with definitive SBRT for a complete of 47 benign major backbone tumors between 2004 and 2016. SBRT consisted of 9-21 Gy in 1-Three fractions utilizing the CyberKnife (n = 11 [23%]), Synergy S (n = 21 [45%]), or TrueBeam (n = 15 [32%]) radiosurgery platform. For a comparability of SBRT doses, sufferers had been dichotomized into 1 of two teams (low-dose or high-dose SBRT) utilizing a cutoff biologically efficient dose (BED10Gy) of 30 Gy. Tumor management was calculated from the date of SBRT to the final follow-up utilizing Kaplan-Meier survival evaluation, with comparisons between teams accomplished utilizing a log-rank methodology. To account for potential indication bias, a propensity rating evaluation was accomplished primarily based on the conditional chances of SBRT dose choice. Toxicity was graded utilizing Frequent Terminology Standards for Opposed Occasions model four.zero with a give attention to grade Three+ toxicity and the incidence of ache flare. RESULTS For the 38 sufferers, the most typical histological findings had been meningioma (15 sufferers), schwannoma (13 sufferers), and hemangioblastoma (7 sufferers). The median age at SBRT was 58 years (vary 25-91 years). The 47 handled lesions had been positioned within the cervical (n = 18), thoracic (n = 19), or lumbosacral (n = 10) backbone. 5 (11%) lesions had been misplaced to follow-up after SBRT. The median follow-up length for the remaining 42 lesions was 54 months (vary 1.2-133 months). Six (16%) sufferers (with a complete of eight lesions) skilled ache flare after SBRT; no important predictor of ache flare was recognized. No grade Three+ acute- or late-onset complication was famous. The 5-year native management fee was 76% (95% CI 61%-91%). No important distinction in native management in keeping with dose, fractionation, earlier radiation, surgical procedure, tumor histology, age, therapy platform, planning goal quantity, or backbone degree handled was discovered. The 5-year native management charges for low- and high-dose remedies had been 73% (95% CI 53%-93%) and 83% (95% CI 61%-100%) (p = zero.52). In propensity score-adjusted multivariable evaluation, no distinction in native management was recognized (HR zero.30, 95% CI zero.02-5.40; p = zero.41). CONCLUSIONS Lengthy-term follow-up of sufferers handled with SBRT for benign spinal lesions revealed no important distinction between low-dose (BED10Gy ? 30) and high-dose SBRT in native management, pain-flare fee, or long-term toxicity.
PMID: 29799334 [PubMed – as supplied by publisher]