Histologic classifier of radiosensitivity to spine stereotactic body radiation therapy Journal Article


Authors: Jackson, C. B.; Boe, L. A.; Zhang, L.; Apte, A.; Jackson, A.; Ruppert, L. M.; Haseltine, J.; Mueller, B. A.; Schmitt, A. M.; Vaynrub, M.; Newman, W. C.; Lis, E.; Barzilai, O.; Bilsky, M. H.; Yamada, Y.; Higginson, D. S.
Article Title: Histologic classifier of radiosensitivity to spine stereotactic body radiation therapy
Abstract: Purpose: Spine stereotactic body radiation therapy (SBRT) outperforms conventional radiation therapy in preventing local failure (LF). Data comparing dose-fractionation schemes on the likelihood of LF and vertebral compression fracture (VCF) are limited. Methods and Materials: This is a retrospective cohort study of 1838 patients (2702 lesions) treated between 2014 and 2023 at a single institution with de novo spine SBRT. LF was defined as progressive disease on magnetic resonance imaging. VCF was defined as progressive or new fracture on magnetic resonance imaging without LF. Death was considered a competing risk. Results: Median follow-up after SBRT for surviving patients was 25 months (IQR 13-43 months). Twelve hundred one lesions (44%) received 27 Gy in 3 fractions, 931 (34%) received 30 Gy in 3 fractions, and 574 lesions (21%) received 24 Gy in 1 fraction. Three hundred nine treatment courses involved separation surgery (11%), and 311 lesions (11%) were epidural spinal cord compression score 2 to 3. For lesions treated with 24 Gy in 1 fraction, 30 Gy in 3 fractions, and 27 Gy in 3 fractions, 2-year LF rates (95% CI) were 7% (5%-9%), 11% (9%-13%), and 17% (15%-20%), respectively (P < .001). Two-year VCF rates (95% CI) requiring stabilization were 10% (8%-13%; 24 Gy in 1 fraction), 2% (1%-3%; 27 Gy in 3 fractions), and 3% (2%-5%; 30 Gy in 3 fractions) (P < .001). For the 3-fraction regimens specifically, 30 Gy was associated with a higher overall VCF rate (P = .022) and lower LF rate (P < .001), but there was no significant difference in the risk of VCF requiring intervention (P = .15). Univariable and multivariable regression revealed histologic-based differences in LF: 2-year LF rates were 8.6% (95% CI, 6.4%-11%) for class A lesions (prostate and breast cancers), 26% (95% CI, 20%-32%) for class C lesions (cholangio-, hepatocellular, and colorectal carcinoma), and 13% (95% CI, 12%-15%) for class B lesions (other histologies) (P < .001). For class B to C, epidural spinal cord compression 2 to 3 lesions (n = 261), surgery plus SBRT reduced LF compared to SBRT alone (7.9 vs 20% at 2 years, P = .051), though this did not reach statistical significance. Conclusions: The preferred hypofractionated SBRT regimen—even for class A histologies—is 30 Gy in 3 fractions, offering superior local control with similar risk of VCF requiring intervention, compared to 27 Gy. For class B to C lesions with high-grade epidural disease, separation surgery prior to SBRT may improve local control. © 2025
Keywords: fracture; radiotherapy; spinal cord compression; local control; fractionation; stereotactic body radiation therapy; local failure; failure rate; compression fracture; vertebral compression; class a; class b; fracture rates
Journal Title: International Journal of Radiation Oncology, Biology, Physics
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Publication status: Online ahead of print
Date Published: 2025-06-16
Online Publication Date: 2025-06-16
Language: English
DOI: 10.1016/j.ijrobp.2025.05.078
PUBMED: 40516631
PROVIDER: scopus
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Daniel S. Higginson -- Source: Scopus
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
  1. Eric Lis
    139 Lis
  2. Yoshiya Yamada
    480 Yamada
  3. Boris A Mueller
    106 Mueller
  4. Mark H Bilsky
    321 Bilsky
  5. Andrew Jackson
    255 Jackson
  6. Aditya Apte
    206 Apte
  7. Lisa Marie Ruppert
    32 Ruppert
  8. Adam Michael Schmitt
    52 Schmitt
  9. Lei Zhang
    33 Zhang
  10. Maksim Vaynrub
    37 Vaynrub
  11. William Christopher Newman
    27 Newman
  12. Christopher Brian Jackson
    11 Jackson
  13. Lillian Augusta Boe
    82 Boe