Helical tomotherapy for spine oligometastases from gastrointestinal malignancies

Abstract

PurposeThis study evaluated the treatment effectiveness and proper radiation dose of helical tomotherapy (HT) in spine oligometastases from gastrointestinal cancers.Materials and MethodsFrom 2006 to 2010, 20 gastrointestinal cancer patients were treated with HT for spine oligometastases (31 spine lesions). The gross tumor volume (GTV) was the tumor evident from magnetic resonance imaging images fused with simulation computed tomography images. Clinical target volume (CTV) encompassed involved vertebral bodies or dorsal elements. We assumed that the planning target volume was equal to the CTV. We assessed local control rate after HT for 31 spine metastases. Pain response was scored by using a numeric pain intensity scale (NPIS, from 0 to 10).ResultsSpine metastatic lesions were treated with median dose of 40 Gy (range, 24 to 51 Gy) and median 5 Gy per fraction (range, 2.5 to 8 Gy) to GTV with median 8 fractions (range, 3 to 20 fraction). Median biologically equivalent dose (BED, α/β = 10 Gy) was 52 Gy10 (range, 37.5 to 76.8 Gy10) to GTV. Six month local control rate for spine metastasis was 90.3%. Overall infield failure rate was 15% and outfield failure rate was 75%. Most patients showed pain relief after HT (93.8%). Median local recurrence free survival was 3 months. BED over 57 Gy10 and oligometastases were identified as prognostic factors associated with improved local progression free survival (p = 0.012, p = 0.041).ConclusionHT was capable of delivering higher BED to metastatic lesions in close proximity of the spinal cord. Spine metastases from gastrointestinal tumors were sensitive to high dose radiation, and BED (α/β = 10 Gy) higher than 57 Gy10 could improve local control.

High dose and compartmental target volume may improve patient outcome after radiotherapy for pelvic bone metastases from hepatocellular carcinoma

“…To date, several studies described clinical features and radiotherapeutic strategies in HCC patients with bone metastasis, and many studies have evaluated stereotactic body RT for spine metastasis. [ 5 – 8 ] Unlike vertebral metastases, few studies have evaluated HCC patients with pelvic bone metastasis. The pelvic skeleton supports the balance of the trunk and has a complex bone anatomy.…”

Helical tomotherapy for cancer treatment: a rapid health technology assessment

“…Toxicities caused by HT and sliding window (SW)‐IMRT for oropharyngeal cancer were all low; however, toxicities associated with HT were less severe than those associated with SW‐IMRT (Table ). xii Spinal tumor/metastasis: the results of 4 observational studies ( n = 104) showed that, there was no severe toxicity associated with HT for spinal tumor/metastasis. The 1‐year survival rate was 67–73%, and the median and recurrence‐free median survival times were 5.1 months and 3 months, respectively; and the pain relief rate was 93.8% (Table ).…”

“…A total of 145 original studies ( n = 6992) were included in the analysis (mainly including CCTs and observational studies) (Table ). Fourteen types of cancer (82%) were assessed in the present study.…”

Feasibility and response of helical tomotherapy in patients with metastatic colorectal cancer

“…HT is a unique IMRT machine, with a different dose delivery and treatment plan prescription compared to conventional linear accelerators-based IMRT, enabling treatment implementation for a wide spectrum of clinical cases, ranging from very small tumor to vast target volumes [ 15 ]. A few studies of HT in patients with metastatic cancer have reported effectiveness with a symptom control rates of 76%-90% within a time frame as short as 6 months [ 16 17 18 ]. In terms of colorectal oligometastases, several studies have reported CR rates of 16%-35% and 1-year LPFS rates of 54%-87% after HT [ 11 19 20 21 ].…”