Myositis following spine radiosurgery for metastatic disease: A case series Journal Article

Authors: Lockney, D. T.; Jia, A. Y.; Lis, E.; Lockney, N. A.; Liu, C.; Hopkins, B.; Higginson, D. S.; Yamada, Y.; Laufer, I.; Bilsky, M.; Schmitt, A. M.
Article Title: Myositis following spine radiosurgery for metastatic disease: A case series
Abstract: OBJECTIVE Spinal stereotactic body radiation therapy (SBRT) has emerged as an attractive method to deliver high doses of radiation to oligometastatic spinal tumors with radioresistant histology. Because SBRT is a palliative therapy, attention to potential radiation toxicities is paramount when counseling patients. The objective of this study was to report radiation-induced myositis after SBRT, a previously undescribed complication. METHODS A total of 667 patients received 891 spine SBRT treatments (either 24 Gy in 1 fraction or 27 Gy in 3 fractions) from 2011 to 2016 and underwent retrospective review. Eleven patients were identified as having radiographic evidence of myositis following SBRT. Clinical and pathologic results were collected, including receipt of anti–vascular endothelial growth factor (VEGF) therapy, radiation dose, equivalent dose in 2-Gy fractions (EQD2), biologically effective dose (BED), and volume of muscle treated. Treatment toxicities were classified according to the Common Terminology Criteria for Adverse Events (CTCAE; version 4.03). Univariate statistical analyses were performed to evaluate the relationships between radiation fractionation schedule and myositis and between anti-VEGF therapy and myositis. RESULTS The cumulative incidence of myositis was 1.9% at 1 year. The median of the mean dose administered to muscle with myositis was 17.5 Gy. The median EQD2 was 55.1 Gy, and the median BED was 82.7 Gy. The median time to the development of clinical symptoms was 1.4 months, while the median time to imaging evidence was 4.7 months. Two patients (18.2%) had CTCAE grade 3 complications. Single-fraction spine SBRT (HR 4.5, 95% CI 1.2–16.9; p = 0.027) was associated with increased risk of developing myositis whereas receipt of anti-VEGF therapy was not (HR 2.2, 95% CI 0.6–7.1; p = 0.2). CONCLUSIONS Radiation myositis following spinal radiosurgery is a rare but important complication. Single-fraction treatment schedules may be associated with increased risk of myositis but should be validated in a larger series. © AANS 2018.
Keywords: radiation; oncology; complications; sbrt; spine radiosurgery; myositis
Journal Title: Journal of Neurosurgery: Spine
Volume: 28
Issue: 4
ISSN: 1547-5654
Publisher: American Association of Neurological Surgeons  
Date Published: 2018-04-01
Start Page: 416
End Page: 421
Language: English
DOI: 10.3171/2017.8.spine17162
PROVIDER: scopus
PUBMED: 29372858
PMCID: PMC5993541
Notes: Article -- Export Date: 2 July 2018 -- Source: Scopus
Citation Impact
MSK Authors
  1. Eric Lis
    123 Lis
  2. Yoshiya Yamada
    441 Yamada
  3. Mark H Bilsky
    280 Bilsky
  4. Ilya Laufer
    141 Laufer
  5. Natalie Ausborn Lockney
    33 Lockney
  6. Adam Michael Schmitt
    42 Schmitt
  7. Angela Y Jia
    2 Jia
  8. Chengbao Liu
    1 Liu