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Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis

PURPOSE: To evaluate patient selection criteria, methodology, safety and clinical outcomes of stereotactic body radiotherapy (SBRT) for treatment of vertebral metastases. MATERIALS AND METHODS: Eight centers from the United States (n = 5), Canada (n = 2) and Germany (n = 1) participated in the retro...

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Autores principales: Guckenberger, Matthias, Mantel, Frederick, Gerszten, Peter C, Flickinger, John C, Sahgal, Arjun, Létourneau, Daniel, Grills, Inga S, Jawad, Maha, Fahim, Daniel K, Shin, John H, Winey, Brian, Sheehan, Jason, Kersh, Ron
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4205292/
https://www.ncbi.nlm.nih.gov/pubmed/25319530
http://dx.doi.org/10.1186/s13014-014-0226-2
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author Guckenberger, Matthias
Mantel, Frederick
Gerszten, Peter C
Flickinger, John C
Sahgal, Arjun
Létourneau, Daniel
Grills, Inga S
Jawad, Maha
Fahim, Daniel K
Shin, John H
Winey, Brian
Sheehan, Jason
Kersh, Ron
author_facet Guckenberger, Matthias
Mantel, Frederick
Gerszten, Peter C
Flickinger, John C
Sahgal, Arjun
Létourneau, Daniel
Grills, Inga S
Jawad, Maha
Fahim, Daniel K
Shin, John H
Winey, Brian
Sheehan, Jason
Kersh, Ron
author_sort Guckenberger, Matthias
collection PubMed
description PURPOSE: To evaluate patient selection criteria, methodology, safety and clinical outcomes of stereotactic body radiotherapy (SBRT) for treatment of vertebral metastases. MATERIALS AND METHODS: Eight centers from the United States (n = 5), Canada (n = 2) and Germany (n = 1) participated in the retrospective study and analyzed 301 patients with 387 vertebral metastases. No patient had been exposed to prior radiation at the treatment site. All patients were treated with linac-based SBRT using cone-beam CT image-guidance and online correction of set-up errors in six degrees of freedom. RESULTS: 387 spinal metastases were treated and the median follow-up was 11.8 months. The median number of consecutive vertebrae treated in a single volume was one (range, 1-6), and the median total dose was 24 Gy (range 8-60 Gy) in 3 fractions (range 1-20). The median EQD2(10) was 38 Gy (range 12-81 Gy). Median overall survival (OS) was 19.5 months and local tumor control (LC) at two years was 83.9%. On multivariate analysis for OS, male sex (p < 0.001; HR = 0.44), performance status <90 (p < 0.001; HR = 0.46), presence of visceral metastases (p = 0.007; HR = 0.50), uncontrolled systemic disease (p = 0.007; HR = 0.45), >1 vertebra treated with SBRT (p = 0.04; HR = 0.62) were correlated with worse outcomes. For LC, an interval between primary diagnosis of cancer and SBRT of ≤30 months (p = 0.01; HR = 0.27) and histology of primary disease (NSCLC, renal cell cancer, melanoma, other) (p = 0.01; HR = 0.21) were correlated with worse LC. Vertebral compression fractures progressed and developed de novo in 4.1% and 3.6%, respectively. Other adverse events were rare and no radiation induced myelopathy reported. CONCLUSIONS: This multi-institutional cohort study reports high rates of efficacy with spine SBRT. At this time the optimal fractionation within high dose practice is unknown.
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spelling pubmed-42052922014-10-23 Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis Guckenberger, Matthias Mantel, Frederick Gerszten, Peter C Flickinger, John C Sahgal, Arjun Létourneau, Daniel Grills, Inga S Jawad, Maha Fahim, Daniel K Shin, John H Winey, Brian Sheehan, Jason Kersh, Ron Radiat Oncol Research PURPOSE: To evaluate patient selection criteria, methodology, safety and clinical outcomes of stereotactic body radiotherapy (SBRT) for treatment of vertebral metastases. MATERIALS AND METHODS: Eight centers from the United States (n = 5), Canada (n = 2) and Germany (n = 1) participated in the retrospective study and analyzed 301 patients with 387 vertebral metastases. No patient had been exposed to prior radiation at the treatment site. All patients were treated with linac-based SBRT using cone-beam CT image-guidance and online correction of set-up errors in six degrees of freedom. RESULTS: 387 spinal metastases were treated and the median follow-up was 11.8 months. The median number of consecutive vertebrae treated in a single volume was one (range, 1-6), and the median total dose was 24 Gy (range 8-60 Gy) in 3 fractions (range 1-20). The median EQD2(10) was 38 Gy (range 12-81 Gy). Median overall survival (OS) was 19.5 months and local tumor control (LC) at two years was 83.9%. On multivariate analysis for OS, male sex (p < 0.001; HR = 0.44), performance status <90 (p < 0.001; HR = 0.46), presence of visceral metastases (p = 0.007; HR = 0.50), uncontrolled systemic disease (p = 0.007; HR = 0.45), >1 vertebra treated with SBRT (p = 0.04; HR = 0.62) were correlated with worse outcomes. For LC, an interval between primary diagnosis of cancer and SBRT of ≤30 months (p = 0.01; HR = 0.27) and histology of primary disease (NSCLC, renal cell cancer, melanoma, other) (p = 0.01; HR = 0.21) were correlated with worse LC. Vertebral compression fractures progressed and developed de novo in 4.1% and 3.6%, respectively. Other adverse events were rare and no radiation induced myelopathy reported. CONCLUSIONS: This multi-institutional cohort study reports high rates of efficacy with spine SBRT. At this time the optimal fractionation within high dose practice is unknown. BioMed Central 2014-10-16 /pmc/articles/PMC4205292/ /pubmed/25319530 http://dx.doi.org/10.1186/s13014-014-0226-2 Text en © Guckenberger et al.; licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Guckenberger, Matthias
Mantel, Frederick
Gerszten, Peter C
Flickinger, John C
Sahgal, Arjun
Létourneau, Daniel
Grills, Inga S
Jawad, Maha
Fahim, Daniel K
Shin, John H
Winey, Brian
Sheehan, Jason
Kersh, Ron
Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis
title Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis
title_full Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis
title_fullStr Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis
title_full_unstemmed Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis
title_short Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis
title_sort safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4205292/
https://www.ncbi.nlm.nih.gov/pubmed/25319530
http://dx.doi.org/10.1186/s13014-014-0226-2
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