Cargando…

Stereotactic spine radiosurgery: Review of safety and efficacy with respect to dose and fractionation

BACKGROUND: Stereotactic body radiotherapy (SBRT) is an emerging treatment option for spinal metastases with demonstrated efficacy in the upfront, postoperative, and re-treatment settings, as well as for tumor histologies considered radioresistant. Uncertainty exists regarding the optimal dose and f...

Descripción completa

Detalles Bibliográficos
Autores principales: Huo, Michael, Sahgal, Arjun, Pryor, David, Redmond, Kristin, Lo, Simon, Foote, Matthew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5339918/
https://www.ncbi.nlm.nih.gov/pubmed/28303210
http://dx.doi.org/10.4103/2152-7806.200581
_version_ 1782512745021702144
author Huo, Michael
Sahgal, Arjun
Pryor, David
Redmond, Kristin
Lo, Simon
Foote, Matthew
author_facet Huo, Michael
Sahgal, Arjun
Pryor, David
Redmond, Kristin
Lo, Simon
Foote, Matthew
author_sort Huo, Michael
collection PubMed
description BACKGROUND: Stereotactic body radiotherapy (SBRT) is an emerging treatment option for spinal metastases with demonstrated efficacy in the upfront, postoperative, and re-treatment settings, as well as for tumor histologies considered radioresistant. Uncertainty exists regarding the optimal dose and fractionation schedule, with single and multifraction regimens commonly utilized. METHODS: A literature search of the PubMed and Medline databases was conducted to identify papers specific to spine SBRT and the effect of varying dose/fractionation regimens on outcomes. Bibliographies of relevant papers were searched for further references, and international spine SBRT experts were consulted. RESULTS: Local control rates generally exceed 80% at 1 year, while high rates of pain control have been attained. There is insufficient evidence to suggest superiority of either single or multiple fraction regimens with respect to local control and pain control. Low rates of toxicity have been reported, assuming strict dose constraints are respected. Radiation myelopathy may be the most morbid toxicity, although the rates are low. The risk of vertebral compression fracture appears to be associated with higher doses per fraction such as those used in single-fraction regimens. The Spinal Instability Neoplastic Score should be considered when evaluating patients for spine SBRT, and prophylactic stabilisation may be warranted. Pain flare is a relatively common toxicity which may be mediated with prophylactic dexamethasone. Because of the treatment complexity and potentially serious toxicities, strict quality assurance should occur at the organizational, planning, dosimetric, and treatment delivery levels. CONCLUSION: Both single and multifraction regimens are safe and efficacious in spine SBRT for spinal metastases. There may be advantages to hypofractionated treatment over single-fraction regimens with respect to toxicity. Ongoing investigation is underway to define optimal dose and fractionation schedules.
format Online
Article
Text
id pubmed-5339918
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Medknow Publications & Media Pvt Ltd
record_format MEDLINE/PubMed
spelling pubmed-53399182017-03-16 Stereotactic spine radiosurgery: Review of safety and efficacy with respect to dose and fractionation Huo, Michael Sahgal, Arjun Pryor, David Redmond, Kristin Lo, Simon Foote, Matthew Surg Neurol Int Stereotactic: Review Article BACKGROUND: Stereotactic body radiotherapy (SBRT) is an emerging treatment option for spinal metastases with demonstrated efficacy in the upfront, postoperative, and re-treatment settings, as well as for tumor histologies considered radioresistant. Uncertainty exists regarding the optimal dose and fractionation schedule, with single and multifraction regimens commonly utilized. METHODS: A literature search of the PubMed and Medline databases was conducted to identify papers specific to spine SBRT and the effect of varying dose/fractionation regimens on outcomes. Bibliographies of relevant papers were searched for further references, and international spine SBRT experts were consulted. RESULTS: Local control rates generally exceed 80% at 1 year, while high rates of pain control have been attained. There is insufficient evidence to suggest superiority of either single or multiple fraction regimens with respect to local control and pain control. Low rates of toxicity have been reported, assuming strict dose constraints are respected. Radiation myelopathy may be the most morbid toxicity, although the rates are low. The risk of vertebral compression fracture appears to be associated with higher doses per fraction such as those used in single-fraction regimens. The Spinal Instability Neoplastic Score should be considered when evaluating patients for spine SBRT, and prophylactic stabilisation may be warranted. Pain flare is a relatively common toxicity which may be mediated with prophylactic dexamethasone. Because of the treatment complexity and potentially serious toxicities, strict quality assurance should occur at the organizational, planning, dosimetric, and treatment delivery levels. CONCLUSION: Both single and multifraction regimens are safe and efficacious in spine SBRT for spinal metastases. There may be advantages to hypofractionated treatment over single-fraction regimens with respect to toxicity. Ongoing investigation is underway to define optimal dose and fractionation schedules. Medknow Publications & Media Pvt Ltd 2017-02-20 /pmc/articles/PMC5339918/ /pubmed/28303210 http://dx.doi.org/10.4103/2152-7806.200581 Text en Copyright: © 2017 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Stereotactic: Review Article
Huo, Michael
Sahgal, Arjun
Pryor, David
Redmond, Kristin
Lo, Simon
Foote, Matthew
Stereotactic spine radiosurgery: Review of safety and efficacy with respect to dose and fractionation
title Stereotactic spine radiosurgery: Review of safety and efficacy with respect to dose and fractionation
title_full Stereotactic spine radiosurgery: Review of safety and efficacy with respect to dose and fractionation
title_fullStr Stereotactic spine radiosurgery: Review of safety and efficacy with respect to dose and fractionation
title_full_unstemmed Stereotactic spine radiosurgery: Review of safety and efficacy with respect to dose and fractionation
title_short Stereotactic spine radiosurgery: Review of safety and efficacy with respect to dose and fractionation
title_sort stereotactic spine radiosurgery: review of safety and efficacy with respect to dose and fractionation
topic Stereotactic: Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5339918/
https://www.ncbi.nlm.nih.gov/pubmed/28303210
http://dx.doi.org/10.4103/2152-7806.200581
work_keys_str_mv AT huomichael stereotacticspineradiosurgeryreviewofsafetyandefficacywithrespecttodoseandfractionation
AT sahgalarjun stereotacticspineradiosurgeryreviewofsafetyandefficacywithrespecttodoseandfractionation
AT pryordavid stereotacticspineradiosurgeryreviewofsafetyandefficacywithrespecttodoseandfractionation
AT redmondkristin stereotacticspineradiosurgeryreviewofsafetyandefficacywithrespecttodoseandfractionation
AT losimon stereotacticspineradiosurgeryreviewofsafetyandefficacywithrespecttodoseandfractionation
AT footematthew stereotacticspineradiosurgeryreviewofsafetyandefficacywithrespecttodoseandfractionation