Five-year outcomes of high-dose single-fraction spinal stereotactic radiosurgery Journal Article
| Authors: | Moussazadeh, N.; Lis, E.; Katsoulakis, E.; Kahn, S.; Svoboda, M.; Distefano, N. M.; McLaughlin, L.; Bilsky, M. H.; Yamada, Y.; Laufer, I. |
| Article Title: | Five-year outcomes of high-dose single-fraction spinal stereotactic radiosurgery |
| Abstract: | Purpose To characterize local tumor control and toxicity risk in very long-term survivors (>5 years) after high-dose spinal image guided, intensity modulated radiation therapy delivered as single-dose stereotactic radiosurgery (SRS). Previously published spinal SRS outcome analyses have included a heterogeneous population of cancer patients, mostly with short survival. This is the first study reporting the long-term tumor control and toxicity profiles after high-dose single-fraction spinal SRS. Methods and Materials The study population included all patients treated from June 2004 to July 2009 with single-fraction spinal SRS (dose 24 Gy) who had survived at least 5 years after treatment. The endpoints examined included disease progression, surgical or radiation retreatment, in-field fracture development, and radiation-associated toxicity, scored using the Radiation Therapy Oncology Group radiation morbidity scoring criteria and the Common Terminology Criteria for Adverse Events, version 4.0. Local control and fracture development were assessed using Kaplan-Meier analysis. Results Of 278 patients, 31 (11.1%), with 36 segments treated for spinal tumors, survived at least 5 years after treatment and were followed up radiographically and clinically for a median of 6.1 years (maximum 102 months). The histopathologic findings for the 5-year survivors included radiation-resistant metastases in 58%, radiation-sensitive metastases in 22%, and primary bone tumors in 19%. In this selected cohort, 3 treatment failures occurred at a median of 48.6 months, including 2 recurrences in the radiation field and 1 patient with demonstrated progression at the treatment margins. Ten lesions (27.8%) were associated with acute grade 1 cutaneous or gastrointestinal toxicity. Delayed toxicity ≥3 months after treatment included 8 cases (22.2%) of mild neuropathy, 2 (5.6%) of gastrointestinal discomfort, 8 (22.2%) of dermatitides, and 3 (8.3%) of myalgias/myositis. Thirteen treated levels (36.1%) in 12 patients demonstrated progressive vertebral body collapse or endplate fractures at a median of 25.7 months (range 11.6-76.0), of which 5 (14%) became symptomatic and subsequently required percutaneous cement augmentation or surgery. Conclusions In the longest-term series to date, high-dose single-fraction spinal SRS retained an excellent safety profile among long-term survivors (>5 years). © 2015 Elsevier Inc. All rights reserved. |
| Keywords: | adult; aged; middle aged; fracture; treatment failure; major clinical study; intensity modulated radiation therapy; cancer growth; treatment planning; cancer patient; cancer radiotherapy; radiation dose; outcome assessment; follow up; radiation; gastrointestinal symptom; radiotherapy; cohort analysis; patient monitoring; pathology; retrospective study; cancer survivor; postoperative complication; gastrointestinal toxicity; tumors; surgery; stereotactic radiosurgery; cancer control; patient treatment; toxicity; disease control; radiation therapy oncology groups; spine surgery; spine tumor; common terminology criteria; gastrointestinal toxicities; methods and materials; human; male; female; priority journal; article; heterogeneous populations; kaplan-meier analysis; delayed toxicity; endplate fracture; single fraction spinal stereotactic radiosurgery; vertebral body collapse |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 93 |
| Issue: | 2 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2015-10-01 |
| Start Page: | 361 |
| End Page: | 367 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2015.05.035 |
| PROVIDER: | scopus |
| PUBMED: | 26232858 |
| DOI/URL: | |
| Notes: | Export Date: 2 October 2015 -- Source: Scopus |
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