Impact of dose on local failure rates after image-guided reirradiation of recurrent paraspinal metastases Journal Article

Authors: Damast, S.; Wright, J.; Bilsky, M.; Hsu, M.; Zhang, Z.; Lovelock, M.; Cox, B.; Zatcky, J.; Yamada, Y.
Article Title: Impact of dose on local failure rates after image-guided reirradiation of recurrent paraspinal metastases
Abstract: Purpose: To examine the impact of dose on local failure (LF) rates in the re-treatment of recurrent paraspinal metastases with image-guided intensity-modulated radiotherapy (IG-IMRT). Methods and Materials: The records of patients with in-field recurrence after previous spine radiation (median dose, 30 Gy) who received salvage IG-IMRT with either five 4-Gy (20-Gy group, n = 42) or five 6-Gy (30-Gy group, n = 55) daily fractions between January 2003 and August 2008 were reviewed. Institutional practice was 20 Gy before April 2006, when it changed to 30 Gy. A total of 47 cases (48%) were treated adjuvantly, after surgery to decompress epidural disease. LF after IG-IMRT was defined radiographically. Results: The median follow-up was 12.1 months (range, 0.2-63.6 months). The 1-year cumulative incidences of LF after 20 Gy and 30 Gy IG-IMRT were 45% and 26%, respectively (p = 0.04). Of all treatment characteristics examined (20-Gy vs. 30-Gy dose group, dose to 95% of the planned and gross target volume, tumor size, histology, receipt of surgery, and interval between first and second radiation), only dose group had a significant impact on actuarial LF incidence (p = 0.04; unadjusted HR, 0.51; 95% CI, 0.27-0.96). There was no incidence of myelopathy. Conclusions: A significant decrease in LF after IG-IMRT with five 6-Gy fractions compared with five 4-Gy fractions was observed without increased risk of myelopathy. Until prospective data comparing stereotactic hypofractionated and single-fraction regimens become available, when reirradiating recurrent paraspinal metastases with IG-IMRT, administration of five 6-Gy daily fractions is reasonable. © 2011 Elsevier Inc.
Keywords: adolescent; adult; controlled study; aged; aged, 80 and over; middle aged; treatment failure; young adult; major clinical study; intensity modulated radiation therapy; salvage therapy; follow-up studies; prospective study; metastasis; neoplasm recurrence, local; tumor volume; radiotherapy dosage; radiotherapy; pathology; physical therapy; tumors; radiotherapy, intensity-modulated; tumor burden; radiosurgery; decompression, surgical; spinal neoplasms; surgery; retreatment; spinal cord disease; image-guided radiation therapy; reirradiation; paraspinal; spinal cords; paraspinal tumors; spinal cord metastases; recurrent paraspinal metastasis; radiotherapy, image-guided
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 81
Issue: 3
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2011-11-01
Start Page: 819
End Page: 826
Language: English
DOI: 10.1016/j.ijrobp.2010.06.013
PROVIDER: scopus
PUBMED: 20888133
Notes: --- - "Export Date: 2 November 2011" - "CODEN: IOBPD" - "Source: Scopus"
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MSK Authors
  1. Zhigang Zhang
    244 Zhang
  2. Brett Wayne Cox
    62 Cox
  3. Meier Hsu
    105 Hsu
  4. Yoshiya Yamada
    361 Yamada
  5. Mark H Bilsky
    225 Bilsky
  6. Shari Damast
    10 Damast
  7. Joan M Zatcky
    36 Zatcky
  8. Dale M Lovelock
    141 Lovelock