Correlation of local failure with measures of dose insufficiency in the high-dose single-fraction treatment of bony metastases Journal Article
| Authors: | Lovelock, D. M.; Zhang, Z.; Jackson, A.; Keam, J.; Bekelman, J.; Bilsky, M.; Lis, E.; Yamada, Y. |
| Article Title: | Correlation of local failure with measures of dose insufficiency in the high-dose single-fraction treatment of bony metastases |
| Abstract: | Purpose: In the setting of high-dose single-fraction image-guided radiotherapy of spine metastases, the delivered dose is hypothesized to be a significant factor in local control. We investigated the dependence of local control on measures of dose insufficiency. Methods and Materials: The minimum doses received by the hottest 100%, 98%, and 95% (Dmin, D98, and D95) of the gross target volume (GTV) were computed for 91 consecutively treated lesions observed in 79 patients. Prescribed doses of 18-24 Gy were delivered in a single fraction. The spinal cord and cauda equina were constrained to a maximum dose of 12-14 Gy and 16 Gy, respectively. A rank-sum test was used to assess the differences between radiographic local failure and local control. Results: With a median follow-up of 18 months, seven local failures have occurred. The distributions of GTV Dmin, D98, and D95 for treatments resulting in local failure were found to be statistically different from the corresponding distributions of the patient group as a whole. Taking no account of histology, p values calculated for Dmin, D98, and D95 were 0.004, 0.012, and 0.031, respectively. No correlations between local failure and target volume or between local failure and anatomic location were found. Conclusions: The results indicate that Dmin, D98, and D95 may be important risk factors for local failure. No local failures in any histology were observed when Dmin was >15 Gy, suggesting that this metric may be an important predictor of local control. © 2010 Elsevier Inc. All rights reserved. |
| Keywords: | bone neoplasms; treatment failure; retrospective studies; major clinical study; bone metastasis; cancer radiotherapy; follow up; radiotherapy dosage; radiotherapy; risk factors; pathology; retrospective study; histology; risk assessment; tumor burden; dosimetry; radiation dose fractionation; disease progression; spinal cord; spinal neoplasms; local control; cancer control; p-values; target volumes; prostheses and implants; high dose; dose insufficiency; high-dose single-fraction radiotherapy; local failure; paraspinal metastasis; cauda equina; fraction images; paraspinal; rank sum tests; significant factors; spinal cords; therapeutic error; pelvic bones |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 77 |
| Issue: | 4 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2010-07-15 |
| Start Page: | 1282 |
| End Page: | 1287 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2009.10.003 |
| PUBMED: | 20350795 |
| PROVIDER: | scopus |
| PMCID: | PMC3319455 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: IOBPD" - "Source: Scopus" |
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