High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions Journal Article

Authors: Yamada, Y.; Bilsky, M. H.; Lovelock, D. M.; Venkatraman, E. S.; Toner, S.; Johnson, J.; Zatcky, J.; Zelefsky, M. J.; Fuks, Z.
Article Title: High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions
Abstract: Purpose: To report tumor control and toxicity for patients treated with image-guided intensity-modulated radiotherapy (RT) for spinal metastases with high-dose single-fraction RT. Methods and Materials: A total of 103 consecutive spinal metastases in 93 patients without high-grade epidural spinal cord compression were treated with image-guided intensity-modulated RT to doses of 18-24 Gy (median, 24 Gy) in a single fraction between 2003 and 2006. The spinal cord dose was limited to a 14-Gy maximal dose. The patients were prospectively examined every 3-4 months with clinical assessment and cross-sectional imaging. Results: The overall actuarial local control rate was 90% (local failure developed in 7 patients) at a median follow-up of 15 months (range, 2-45 months). The median time to local failure was 9 months (range, 2-15 months) from the time of treatment. Of the 93 patients, 37 died. The median overall survival was 15 months. In all cases, death was from progression of systemic disease and not local failure. The histologic type was not a statistically significant predictor of survival or local control. The radiation dose was a significant predictor of local control (p = 0.03). All patients without local failure also reported durable symptom palliation. Acute toxicity was mild (Grade 1-2). No case of radiculopathy or myelopathy has developed. Conclusion: High-dose, single-fraction image-guided intensity-modulated RT is a noninvasive intervention that appears to be safe and very effective palliation for patients with spinal metastases, with minimal negative effects on quality of life and a high probability of tumor control. © 2008 Elsevier Inc. All rights reserved.
Keywords: adult; cancer survival; controlled study; aged; aged, 80 and over; middle aged; survival rate; treatment failure; major clinical study; disease course; intensity modulated radiation therapy; salvage therapy; doxorubicin; radiation dose; follow up; prospective studies; image analysis; radiotherapy dosage; radiotherapy; palliative therapy; patient monitoring; oncology; cancer mortality; time factors; intensity-modulated radiotherapy; medical imaging; radiotherapy, intensity-modulated; dosimetry; spinal cord; spinal cord compression; spinal neoplasms; bone; radiation injuries; radiotherapy planning, computer-assisted; cancer control; disease control; spinal cord metastasis; spinal cord disease; cone-beam computed tomography; spinal metastases; radiculopathy; image-guided radiotherapy; single fraction
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 71
Issue: 2
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2008-06-01
Start Page: 484
End Page: 490
Language: English
DOI: 10.1016/j.ijrobp.2007.11.046
PUBMED: 18234445
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 61" - "Export Date: 17 November 2011" - "CODEN: IOBPD" - "Source: Scopus"
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MSK Authors
  1. Venkatraman Ennapadam Seshan
    288 Seshan
  2. Zvi Fuks
    312 Fuks
  3. Michael J Zelefsky
    624 Zelefsky
  4. Yoshiya Yamada
    359 Yamada
  5. Sean T Toner
    8 Toner
  6. Mark H Bilsky
    223 Bilsky
  7. Joan M Zatcky
    36 Zatcky
  8. Dale M Lovelock
    141 Lovelock