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Clinical Outcomes of Dose-Escalated Hypofractionated External Beam Radiation Therapy (5 Gy × 5 Fractions) for Spine Metastasis

PURPOSE: The objective of this study was to determine the toxicities and outcomes of patients with spinal metastasis treated with external beam radiation therapy (EBRT) to 25 Gy in 5 fractions. METHODS AND MATERIALS: Data were extracted from an institutional tumor registry for patients with spinal m...

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Autores principales: Shin, Jacob Y., Mathis, Noah J., Wijetunga, Neil Ari, Yerramilli, Divya, Higginson, Daniel S., Schmitt, Adam M., Gomez, Daniel R., Yamada, Yoshiya J., Yang, Jonathan T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8917266/
https://www.ncbi.nlm.nih.gov/pubmed/35287317
http://dx.doi.org/10.1016/j.adro.2022.100906
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author Shin, Jacob Y.
Mathis, Noah J.
Wijetunga, Neil Ari
Yerramilli, Divya
Higginson, Daniel S.
Schmitt, Adam M.
Gomez, Daniel R.
Yamada, Yoshiya J.
Yang, Jonathan T.
author_facet Shin, Jacob Y.
Mathis, Noah J.
Wijetunga, Neil Ari
Yerramilli, Divya
Higginson, Daniel S.
Schmitt, Adam M.
Gomez, Daniel R.
Yamada, Yoshiya J.
Yang, Jonathan T.
author_sort Shin, Jacob Y.
collection PubMed
description PURPOSE: The objective of this study was to determine the toxicities and outcomes of patients with spinal metastasis treated with external beam radiation therapy (EBRT) to 25 Gy in 5 fractions. METHODS AND MATERIALS: Data were extracted from an institutional tumor registry for patients with spinal metastasis who were treated with EBRT to 25 Gy in 5 fractions to their spinal lesion(s). Cox regression and Kaplan-Meier analyses to determine local control and overall survival (OS) were employed. RESULTS: Seventy-five patients with 86 total treated spinal metastatic tumors were identified. The median follow-up was 7 months. The median age was 66 years. Fifty-six patients (75.7%) experienced partial or complete pain relief for a median duration of 6 months (range, 1-33). Fifty-one (59.3%) cases were planned using intensity modulated radiation therapy while 19 (22.1%) employed 3-dimensional conformal radiation therapy and 16 (18.6%) cases used nonconformal radiation technique. Greater than 90% of cases had a point dose maximum to the spinal cord/cauda equina <27.5 Gy. No patient experienced treatment-related myelopathy. The most common toxicities were fatigue (23.3%), pain flare (14.0%), and nausea (8.1%). There were no grade 3 toxicities. One-year local control was 80.6%, and 1-year OS was 38.4%. Higher Karnofsky performance status (P = .001) and radiosensitive tumor histology (P = .014) were significant predictors for better OS. CONCLUSIONS: Our single-institutional retrospective analysis of patients with spinal metastasis suggested that palliative EBRT to 25 Gy in 5 fractions is safe, with a low toxicity profile and minimal risk for myelopathy with an achievable dose maximum to the spinal cord and cauda equina ≤27 Gy (equivalent total dose in 2-Gy fractions ≤50 Gy), and it may provide durable palliation and local control in cases where stereotactic body radiation therapy may not be indicated.
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spelling pubmed-89172662022-03-13 Clinical Outcomes of Dose-Escalated Hypofractionated External Beam Radiation Therapy (5 Gy × 5 Fractions) for Spine Metastasis Shin, Jacob Y. Mathis, Noah J. Wijetunga, Neil Ari Yerramilli, Divya Higginson, Daniel S. Schmitt, Adam M. Gomez, Daniel R. Yamada, Yoshiya J. Yang, Jonathan T. Adv Radiat Oncol Scientific Article PURPOSE: The objective of this study was to determine the toxicities and outcomes of patients with spinal metastasis treated with external beam radiation therapy (EBRT) to 25 Gy in 5 fractions. METHODS AND MATERIALS: Data were extracted from an institutional tumor registry for patients with spinal metastasis who were treated with EBRT to 25 Gy in 5 fractions to their spinal lesion(s). Cox regression and Kaplan-Meier analyses to determine local control and overall survival (OS) were employed. RESULTS: Seventy-five patients with 86 total treated spinal metastatic tumors were identified. The median follow-up was 7 months. The median age was 66 years. Fifty-six patients (75.7%) experienced partial or complete pain relief for a median duration of 6 months (range, 1-33). Fifty-one (59.3%) cases were planned using intensity modulated radiation therapy while 19 (22.1%) employed 3-dimensional conformal radiation therapy and 16 (18.6%) cases used nonconformal radiation technique. Greater than 90% of cases had a point dose maximum to the spinal cord/cauda equina <27.5 Gy. No patient experienced treatment-related myelopathy. The most common toxicities were fatigue (23.3%), pain flare (14.0%), and nausea (8.1%). There were no grade 3 toxicities. One-year local control was 80.6%, and 1-year OS was 38.4%. Higher Karnofsky performance status (P = .001) and radiosensitive tumor histology (P = .014) were significant predictors for better OS. CONCLUSIONS: Our single-institutional retrospective analysis of patients with spinal metastasis suggested that palliative EBRT to 25 Gy in 5 fractions is safe, with a low toxicity profile and minimal risk for myelopathy with an achievable dose maximum to the spinal cord and cauda equina ≤27 Gy (equivalent total dose in 2-Gy fractions ≤50 Gy), and it may provide durable palliation and local control in cases where stereotactic body radiation therapy may not be indicated. Elsevier 2022-02-04 /pmc/articles/PMC8917266/ /pubmed/35287317 http://dx.doi.org/10.1016/j.adro.2022.100906 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Scientific Article
Shin, Jacob Y.
Mathis, Noah J.
Wijetunga, Neil Ari
Yerramilli, Divya
Higginson, Daniel S.
Schmitt, Adam M.
Gomez, Daniel R.
Yamada, Yoshiya J.
Yang, Jonathan T.
Clinical Outcomes of Dose-Escalated Hypofractionated External Beam Radiation Therapy (5 Gy × 5 Fractions) for Spine Metastasis
title Clinical Outcomes of Dose-Escalated Hypofractionated External Beam Radiation Therapy (5 Gy × 5 Fractions) for Spine Metastasis
title_full Clinical Outcomes of Dose-Escalated Hypofractionated External Beam Radiation Therapy (5 Gy × 5 Fractions) for Spine Metastasis
title_fullStr Clinical Outcomes of Dose-Escalated Hypofractionated External Beam Radiation Therapy (5 Gy × 5 Fractions) for Spine Metastasis
title_full_unstemmed Clinical Outcomes of Dose-Escalated Hypofractionated External Beam Radiation Therapy (5 Gy × 5 Fractions) for Spine Metastasis
title_short Clinical Outcomes of Dose-Escalated Hypofractionated External Beam Radiation Therapy (5 Gy × 5 Fractions) for Spine Metastasis
title_sort clinical outcomes of dose-escalated hypofractionated external beam radiation therapy (5 gy × 5 fractions) for spine metastasis
topic Scientific Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8917266/
https://www.ncbi.nlm.nih.gov/pubmed/35287317
http://dx.doi.org/10.1016/j.adro.2022.100906
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