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 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 2 November 2011" - "CODEN: IOBPD" - "Source: Scopus" |
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