Outcomes and toxicity for hypofractionated and single-fraction image-guided stereotactic radiosurgery for sarcomas metastasizing to the spine Journal Article
| Authors: | Folkert, M. R.; Bilsky, M. H.; Tom, A. K.; Oh, J. H.; Alektiar, K. M.; Laufer, I.; Tap, W. D.; Yamada, Y. |
| Article Title: | Outcomes and toxicity for hypofractionated and single-fraction image-guided stereotactic radiosurgery for sarcomas metastasizing to the spine |
| Abstract: | Purpose Conventional radiation treatment (20-40 Gy in 5-20 fractions, 2-5 Gy per fraction) for sarcoma metastatic to the spine provides subtherapeutic doses, resulting in poor durable local control (LC) (50%-77% at 1 year). Hypofractionated (HF) and/or single-fraction (SF) image-guided stereotactic radiosurgery (IG-SRS) may provide a more effective means of managing these lesions. Methods and Materials Patients with pathologically proven high-grade sarcoma metastatic to the spine treated with HF and SF IG-SRS were included. LC and overall survival (OS) were analyzed by the use of Kaplan-Meier statistics. Univariate and multivariate analyses were performed by the use of Cox regression with competing-risks analysis; all confidence intervals are 95%. Toxicities were assessed according to Common Terminology Criteria for Adverse Events, version 4.0. Results From May 2005 to November 11, 2012, 88 patients with 120 discrete metastases received HF (3-6 fractions; median dose, 28.5 Gy; n=52, 43.3%) or SF IG-SRS (median dose, 24 Gy; n=68, 56.7%). The median follow-up time was 12.3 months. At 12 months, LC was 87.9% (confidence interval [CI], 81.3%-94.5%), OS was 60.6% (CI, 49.6%-71.6%), and median survival was 16.9 months. SF IG-SRS demonstrated superior LC to HF IG-SRS (12-month LC of 90.8% [CI, 83%-98.6%] vs 84.1% [CI, 72.9%-95.3%] P=.007) and retained significance on multivariate analysis (P=.030, hazard ratio 0.345; CI, 0.132-0.901]. Treatment was well tolerated, with 1% acute grade 3 toxicity, 4.5% chronic grade 3 toxicity, and no grade >3 toxicities. Conclusions In the largest series of metastatic sarcoma to the spine to date, IG-SRS provides excellent LC in the setting of an aggressive disease with low radiation sensitivity and poor prognosis. Single-fraction IG-SRS is associated with the highest rates of LC with minimal toxicity. © 2014 Elsevier Inc. All rights reserved. |
| Keywords: | adult; cancer survival; aged; middle aged; major clinical study; overall survival; fatigue; outcome assessment; follow up; esophagitis; radiotherapy; cohort analysis; angiosarcoma; radiation injury; risk assessment; sarcoma; confidence interval; fibrosarcoma; tumors; radiation dose fractionation; diagnosis; radiosensitivity; dermatitis; stereotactic radiosurgery; hemangiopericytoma; leiomyosarcoma; solitary fibrous tumor; spindle cell sarcoma; toxicity; acute toxicity; multi variate analysis; multivariant analysis; chondrosarcoma; wound complication; risk analysis; spine metastasis; myxosarcoma; radiation treatments; hypofractionated; fault tolerant computer systems; natural language processing systems; tracheoesophageal fistula; common terminology criteria; image guided radiotherapy; myelitis; chronic toxicity; cancer prognosis; methods and materials; very elderly; human; male; female; priority journal; article; financial data processing |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 88 |
| Issue: | 5 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2014-04-01 |
| Start Page: | 1085 |
| End Page: | 1091 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2013.12.042 |
| PROVIDER: | scopus |
| PUBMED: | 24661662 |
| DOI/URL: | |
| Notes: | Export Date: 1 May 2014 -- CODEN: IOBPD -- Source: Scopus |
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