Stereotactic Radiosurgery for the Remedy of Major and Metastatic Spinal Sarcomas.
Technol Most cancers Res Deal with. 2017 Jun;16(three):276-284
Authors: Miller JA, Balagamwala EH, Angelov L, Suh JH, Djemil T, Magnelli A, Qi P, Zhuang T, Godley A, Chao ST
PURPOSE: Regardless of developments in native and systemic remedy, metastasis stays frequent within the pure historical past of sarcomas. Sadly, such metastases are probably the most vital supply of morbidity and mortality on this heterogeneous illness. As a classically radioresistant histology, stereotactic radiosurgery has emerged to manage spinal sarcomas and supply palliation. Nonetheless, there’s a lack of knowledge relating to ache aid and relapse following stereotactic radiosurgery.
METHODS: We queried a retrospective institutional database of sufferers who underwent backbone stereotactic radiosurgery for main and metastatic sarcomas. The first end result was ache aid following stereotactic radiosurgery. Secondary outcomes included development of ache, radiographic failure, and growth of toxicities following therapy.
RESULTS: Forty therapy websites have been eligible for inclusion; the median prescription dose was 16 Gy in a single fraction. Median time to radiographic failure was 14 months. At 6 and 12 months, radiographic management was 63% and 51%, respectively. Amongst sufferers presenting with ache, median time to ache aid was 1 month. Actuarial ache aid at 6 months was 82%. Median time to ache development was 10 months; at 12 months, actuarial ache development was 51%. Following multivariate evaluation, presence of neurologic deficit at seek the advice of (hazard ratio: 2.48, P < .01) and presence of extraspinal bone metastases (hazard ratio: 2.83, P < .01) have been related to ache aid. Better ache at seek the advice of (hazard ratio: 1.92, P < .01), prior radiotherapy (hazard ratio: four.65, P = .02), and better variety of irradiated vertebral ranges have been related to ache development.
CONCLUSIONS: Native therapy of spinal sarcomas has remained a problem for many years, with poor charges of native management and restricted ache aid following standard radiotherapy. On this sequence, ache aid was achieved in 82% of remedies at 6 months, with half of sufferers experiencing ache development by 12 months. Given minimal toxicity and suboptimal ache management at 12 months, dose escalation past 16 Gy is warranted.
PMID: 27074915 [PubMed – indexed for MEDLINE]