Local failure and vertebral body fracture risk using multifraction stereotactic body radiation therapy for spine metastases
Purpose: Single-fraction radiation surgery for spine metastases is highly effective. However, a high rate (20-39%) of vertebral body fracture (VBF) has been associated with large, single-fraction doses. We report our experience using multifraction stereotactic body radiation therapy (SBRT). Methods...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-07-01
|
| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109418300654 |
| _version_ | 1819292700663349248 |
|---|---|
| author | Nihaal Mehta, BA Peter J. Zavitsanos, MD Krisztina Moldovan, MD Adetokunbo Oyelese, MD, PhD Jared S. Fridley, MD Ziya Gokaslan, MD Timothy J. Kinsella, MD Jaroslaw T. Hepel, MD |
| author_facet | Nihaal Mehta, BA Peter J. Zavitsanos, MD Krisztina Moldovan, MD Adetokunbo Oyelese, MD, PhD Jared S. Fridley, MD Ziya Gokaslan, MD Timothy J. Kinsella, MD Jaroslaw T. Hepel, MD |
| author_sort | Nihaal Mehta, BA |
| collection | DOAJ |
| description | Purpose: Single-fraction radiation surgery for spine metastases is highly effective. However, a high rate (20-39%) of vertebral body fracture (VBF) has been associated with large, single-fraction doses. We report our experience using multifraction stereotactic body radiation therapy (SBRT). Methods and materials: All patients who were treated with multifraction SBRT for spine metastases at our institution between 2009 and 2017 were retrospectively analyzed. SBRT was delivered in 2 to 5 fractions using the Cyberknife System (Accuray, Sunnyvale, CA). Patients were followed clinically and with magnetic resonance imaging every 3 to 6 months. Local control, complications (including VBF), and overall survival were evaluated. Patient, disease, and treatment variables were analyzed for a statistical association with outcomes. Results: A total of 83 patients were treated to 98 spine lesions with a median follow-up of 7.6 months. Histologies included non-small cell lung cancer (NSCLC; 24%), renal cell carcinoma (RCC; 18%), and breast cancer (12%). Surgery or vertebroplasty were performed before SBRT in 21% of cases. Patients received a median SBRT dose of 24 Gy in a median of 3 fractions. Local control was 93% at 6 months and 84% at 1 year. Higher prescribed dose, higher biologic effective dose, higher minimum dose to 90% of the planning target volume, tumor histology, and smaller tumor volume predicted improved local control. The cumulative dose was 23 Gy versus 26 Gy for patients with and without failure (P = .02), higher biologic effective dose 39 Gy versus 46 Gy, (P = .01), and higher minimum dose to 90% of the planning target volume 23 Gy versus 26 Gy (P = .03). VBF occurred in 4.2% of all cases and 5.3% of those without surgery or vertebroplasty prior to SBRT. Only preexisting VBF predicted risk of post-SBRT VBF (P < .01). Conclusions: Multifraction SBRT results in a high local control rate for metastatic spinal disease with a low VBF rate, which suggests a favorable therapeutic ratio compared with single-fraction SBRT. |
| first_indexed | 2024-12-24T03:58:42Z |
| format | Article |
| id | doaj.art-32d5f652f97740ccb7000b74c7442434 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-12-24T03:58:42Z |
| publishDate | 2018-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-32d5f652f97740ccb7000b74c74424342022-12-21T17:16:22ZengElsevierAdvances in Radiation Oncology2452-10942018-07-0133245251Local failure and vertebral body fracture risk using multifraction stereotactic body radiation therapy for spine metastasesNihaal Mehta, BA0Peter J. Zavitsanos, MD1Krisztina Moldovan, MD2Adetokunbo Oyelese, MD, PhD3Jared S. Fridley, MD4Ziya Gokaslan, MD5Timothy J. Kinsella, MD6Jaroslaw T. Hepel, MD7The Warren Alpert Medical School of Brown University, Providence, Rhode IslandDepartment of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, Rhode Island; Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, MassachusettsDepartment of Neurosurgery, Rhode Island Hospital, Brown University, Providence, Rhode IslandDepartment of Neurosurgery, Rhode Island Hospital, Brown University, Providence, Rhode IslandDepartment of Neurosurgery, Rhode Island Hospital, Brown University, Providence, Rhode IslandDepartment of Neurosurgery, Rhode Island Hospital, Brown University, Providence, Rhode IslandDepartment of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, Rhode Island; Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, MassachusettsDepartment of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, Rhode Island; Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, Massachusetts; Corresponding author. Department of Radiation Oncology, Lifespan Cancer Institute, Brown University, 593 Eddy St, Providence, RI 02903.Purpose: Single-fraction radiation surgery for spine metastases is highly effective. However, a high rate (20-39%) of vertebral body fracture (VBF) has been associated with large, single-fraction doses. We report our experience using multifraction stereotactic body radiation therapy (SBRT). Methods and materials: All patients who were treated with multifraction SBRT for spine metastases at our institution between 2009 and 2017 were retrospectively analyzed. SBRT was delivered in 2 to 5 fractions using the Cyberknife System (Accuray, Sunnyvale, CA). Patients were followed clinically and with magnetic resonance imaging every 3 to 6 months. Local control, complications (including VBF), and overall survival were evaluated. Patient, disease, and treatment variables were analyzed for a statistical association with outcomes. Results: A total of 83 patients were treated to 98 spine lesions with a median follow-up of 7.6 months. Histologies included non-small cell lung cancer (NSCLC; 24%), renal cell carcinoma (RCC; 18%), and breast cancer (12%). Surgery or vertebroplasty were performed before SBRT in 21% of cases. Patients received a median SBRT dose of 24 Gy in a median of 3 fractions. Local control was 93% at 6 months and 84% at 1 year. Higher prescribed dose, higher biologic effective dose, higher minimum dose to 90% of the planning target volume, tumor histology, and smaller tumor volume predicted improved local control. The cumulative dose was 23 Gy versus 26 Gy for patients with and without failure (P = .02), higher biologic effective dose 39 Gy versus 46 Gy, (P = .01), and higher minimum dose to 90% of the planning target volume 23 Gy versus 26 Gy (P = .03). VBF occurred in 4.2% of all cases and 5.3% of those without surgery or vertebroplasty prior to SBRT. Only preexisting VBF predicted risk of post-SBRT VBF (P < .01). Conclusions: Multifraction SBRT results in a high local control rate for metastatic spinal disease with a low VBF rate, which suggests a favorable therapeutic ratio compared with single-fraction SBRT.http://www.sciencedirect.com/science/article/pii/S2452109418300654 |
| spellingShingle | Nihaal Mehta, BA Peter J. Zavitsanos, MD Krisztina Moldovan, MD Adetokunbo Oyelese, MD, PhD Jared S. Fridley, MD Ziya Gokaslan, MD Timothy J. Kinsella, MD Jaroslaw T. Hepel, MD Local failure and vertebral body fracture risk using multifraction stereotactic body radiation therapy for spine metastases Advances in Radiation Oncology |
| title | Local failure and vertebral body fracture risk using multifraction stereotactic body radiation therapy for spine metastases |
| title_full | Local failure and vertebral body fracture risk using multifraction stereotactic body radiation therapy for spine metastases |
| title_fullStr | Local failure and vertebral body fracture risk using multifraction stereotactic body radiation therapy for spine metastases |
| title_full_unstemmed | Local failure and vertebral body fracture risk using multifraction stereotactic body radiation therapy for spine metastases |
| title_short | Local failure and vertebral body fracture risk using multifraction stereotactic body radiation therapy for spine metastases |
| title_sort | local failure and vertebral body fracture risk using multifraction stereotactic body radiation therapy for spine metastases |
| url | http://www.sciencedirect.com/science/article/pii/S2452109418300654 |
| work_keys_str_mv | AT nihaalmehtaba localfailureandvertebralbodyfractureriskusingmultifractionstereotacticbodyradiationtherapyforspinemetastases AT peterjzavitsanosmd localfailureandvertebralbodyfractureriskusingmultifractionstereotacticbodyradiationtherapyforspinemetastases AT krisztinamoldovanmd localfailureandvertebralbodyfractureriskusingmultifractionstereotacticbodyradiationtherapyforspinemetastases AT adetokunbooyelesemdphd localfailureandvertebralbodyfractureriskusingmultifractionstereotacticbodyradiationtherapyforspinemetastases AT jaredsfridleymd localfailureandvertebralbodyfractureriskusingmultifractionstereotacticbodyradiationtherapyforspinemetastases AT ziyagokaslanmd localfailureandvertebralbodyfractureriskusingmultifractionstereotacticbodyradiationtherapyforspinemetastases AT timothyjkinsellamd localfailureandvertebralbodyfractureriskusingmultifractionstereotacticbodyradiationtherapyforspinemetastases AT jaroslawthepelmd localfailureandvertebralbodyfractureriskusingmultifractionstereotacticbodyradiationtherapyforspinemetastases |