Clinical Outcomes After Reirradiation of Paraspinal Tumors

Wright, Jean L.; Lovelock, D. Michael; Bilsky, Mark H.; Toner, Sean; Zatcky, J.; Yamada, Yoshiya

doi:10.1097/01.coc.0000227559.32799.db

Cited by 28 publications

(11 citation statements)

References 25 publications

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“…When used effectively, a high therapeutic ratio can be delivered without the need for standard fractionation. In the extreme case, a single fraction can be a sufficient treatment when delivering up to 2000–2400 cGy [1], thereby achieving a high biologically effective dose (BED) to the disease while sparing normal tissues.…”

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confidence: 99%

Low rate of thoracic toxicity in palliative paraspinal single-fraction stereotactic body radiation therapy

Gomez

Hunt

Jackson

et al. 2009

Radiotherapy and Oncology

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Background There has been an increase in the utilization of single-fraction stereotactic body radiation therapy (SBRT) to treat thoracic structures, but there have been few reports describing toxicity outcomes with this treatment. Methods We evaluated 119 sites (114 patients) with no prior history of thoracic radiation were treated from 10/1/2003 to 10/27/2008 with single-fraction SBRT to thoracic structures. The median dose to the gross tumor volume was 2400 cGy (range 1800–2400 cGy), as was the median dose to the planning target volume (range 1600–2400 cGy). A detailed review of thoracic toxicities was performed to include pneumonitis or Grade 2 or higher esophageal and bronchial toxicity. In addition, we retrospectively contoured the esophagus and bronchus of 48 patients treated in 2004–2005, prior to the establishment of dose constraints to determine the range of doses that these structures received. Results Of the contoured patients, the median dose to the hottest 1 cc (D1cc) of the esophagus was 1250 cGy (range 158–2572 cGy). The median bronchial D1cc was 1101 cGy (range 260–2211 cGy). At a median follow-up of 11.6 months, there were seven Grade 2 or higher esophageal toxicities, including one Grade 3 and one Grade 4 toxicities. There were two bronchial toxicities, one Grade 2 and one Grade 3. There were no cases of pneumonitis. Conclusions High-dose single-fraction SBRT is well tolerated to the thoracic region, with most patients tolerating high doses to central structures without significant toxicity.

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confidence: 99%

Low rate of thoracic toxicity in palliative paraspinal single-fraction stereotactic body radiation therapy

Gomez

Hunt

Jackson

et al. 2009

Radiotherapy and Oncology

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“…Early on, Wright et al [32] reviewed their experience in 37 patients with re-EBRT of recurrent paraspinal tumors using image-guided intensity modulated radiotherapy (IG-IMRT). A median dose of 2000 cGy was delivered to the PTV, and the most common radiation schedule was 2000 cGy in 5 fractions.…”

Section: Discussionmentioning

confidence: 99%

CT-Guided ¹²⁵I Seed Interstitial Brachytherapy as a Salvage Treatment for Recurrent Spinal Metastases after External Beam Radiotherapy

Yao

Cao

Wang

et al. 2016

BioMed Research International

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The aim of this study is to evaluate the feasibility, safety, and clinical efficacy of CT-guided 125I seed interstitial brachytherapy in patients with recurrent spinal metastases after external beam radiotherapy (EBRT). Between August 2003 and September 2015, 26 spinal metastatic lesions (24 patients) were reirradiated by this salvage therapy modality. Treatment for all patients was preplanned using a three-dimensional treatment planning system 3–5 days before 125I seed interstitial brachytherapy; dosimetry verification was performed immediately after seed implantation. Median actual D 90 was 99 Gy (range, 90–176), and spinal cord median D max was 39 Gy (range, 6–110). Median local control (LC) was 12 months (95% CI: 7.0–17.0). The 6- and 12-month LC rates were 52% and 40%, respectively. Median overall survival (OS) was 11 months (95% CI: 7.7–14.3); 6-month and 1-, 2-, and 3-year OS rates were 65%, 37%, 14%, and 9%, respectively. Pain-free survival ranged from 2 to 42 months (median, 6; 95% CI: 4.6–7.4). Treatment was well-tolerated, with no radiation-induced vertebral compression fractures or myelopathy reported. Reirradiation with CT-guided 125I seed interstitial brachytherapy appears to be feasible, safe, and effective as pain relief or salvage treatment for patients with recurrent spinal metastases after EBRT.

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“…Wright et al reported outcomes on the re-irradiation of paraspinal tumors in a retrospective cohort of 49 patients, of which 37 were evaluable [16]. Approximately 70% of patients underwent surgery prior to re-irradiation due to high-grade epidural spinal cord compression.…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…Wright et al described spinal cord and cauda equina doses in a cohort of 37 patients who underwent re-irradiation of paraspinal tumors using imaged-guided intensity-modulated radiation therapy [16]. There was no late toxicity reported with a median follow-up of 8 months.…”

Section: Srs and Sbrt Re-irradiationmentioning

confidence: 99%

The role of stereotactic body radiotherapy and stereotactic radiosurgery in the re-irradiation of metastatic spinal tumors

Jain

Yamada

2014

Expert Review of Anticancer Therapy

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Stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS) are advanced radiotherapy delivery techniques that allow for the delivery of high-dose per fraction radiation. Advances in imaging technology and intensity modulation have allowed SRS and SBRT to be used for the treatment of tumors in close proximity to the spinal cord and cauda equina, in particular spinal metastases. While the initial treatment of spinal metastases is often conventional palliative radiotherapy, treatment failure is not uncommon, and conventional re-irradiation may not be feasible due to spinal cord tolerance. SBRT and SRS have emerged as important techniques for the treatment of spinal metastases in the proximity of previously irradiated spinal cord. Here we review the current data on the use of SBRT and SRS spinal re-irradiation, and future directions for these important treatment modalities.

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Clinical Outcomes After Reirradiation of Paraspinal Tumors

Abstract: Reirradiation using IG-IMRT is safe and achieves a meaningful interval of local control with improved symptoms. Further studies with more patients and longer follow up are needed to evaluate toxicity, predictors of failure, and timing of radiation after surgical salvage.

Cited by 28 publications

References 25 publications

Low rate of thoracic toxicity in palliative paraspinal single-fraction stereotactic body radiation therapy

Low rate of thoracic toxicity in palliative paraspinal single-fraction stereotactic body radiation therapy

CT-Guided ¹²⁵I Seed Interstitial Brachytherapy as a Salvage Treatment for Recurrent Spinal Metastases after External Beam Radiotherapy

The role of stereotactic body radiotherapy and stereotactic radiosurgery in the re-irradiation of metastatic spinal tumors

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Clinical Outcomes After Reirradiation of Paraspinal Tumors

Abstract: Reirradiation using IG-IMRT is safe and achieves a meaningful interval of local control with improved symptoms. Further studies with more patients and longer follow up are needed to evaluate toxicity, predictors of failure, and timing of radiation after surgical salvage.

Cited by 28 publications

References 25 publications

Low rate of thoracic toxicity in palliative paraspinal single-fraction stereotactic body radiation therapy

Low rate of thoracic toxicity in palliative paraspinal single-fraction stereotactic body radiation therapy

CT-Guided 125I Seed Interstitial Brachytherapy as a Salvage Treatment for Recurrent Spinal Metastases after External Beam Radiotherapy

The role of stereotactic body radiotherapy and stereotactic radiosurgery in the re-irradiation of metastatic spinal tumors

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CT-Guided ¹²⁵I Seed Interstitial Brachytherapy as a Salvage Treatment for Recurrent Spinal Metastases after External Beam Radiotherapy