Oligometastatic Disease State Is Associated with Improved Local Control in Patients Undergoing Three or Five Fraction Spine Stereotactic Body Radiotherapy

Silva, Scott R.; Gliniewicz, A.D.; Martin, Brendan; Prabhu, Vikram C.; Germanwala, Anand V.; Melian, Edward; Jones, Gary E.

doi:10.1016/j.wneu.2018.10.044

Cited by 16 publications

(11 citation statements)

References 36 publications

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“…In 7 reports of postoperative SBRT, local control at 1 year ranged from 85% to 100% per report, with median follow-ups ranging from 6.1 to 30 months. 13,[21][22][23][24][25][26][27][28] These retrospective and prospective se-ries typically included heterogeneous mixtures of patients with bone-only disease, mechanical instability, and lowand high-grade epidural disease. Our group has previously reported a 1-year local control rate of 83.6% in 186 patients undergoing a combination of single-fraction and hypofractionated SBRT following separation surgery (77.4% 1-year local control with low-dose hypofractionated SBRT, 95.9% with high-dose hypofractionated SBRT).…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated spinal stereotactic body radiation therapy for high-grade epidural disease

Rothrock¹,

Lis

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVETo characterize the clinical outcomes when stereotactic body radiation therapy (SBRT) alone is used to treat high-grade epidural disease without prior surgical decompression, the authors conducted a retrospective cohort study of patients treated at the Memorial Sloan Kettering Cancer Center between 2014 and 2018. The authors report locoregional failure (LRF) for a cohort of 31 cases treated with hypofractionated SBRT alone for grade 2 epidural spinal cord compression (ESCC) with radioresistant primary cancer histology.METHODSHigh-grade epidural disease was defined as grade 2 ESCC, which is notable for radiographic deformation of the spinal cord by metastatic disease. Kaplan-Meier survival curves and cumulative incidence functions were generated to examine the survival and incidence experiences of the sample level with respect to overall survival, LRF, and subsequent requirement of vertebral same-level surgery (SLS) due to tumor progression or fracture. Associations with dosimetric analysis were also examined.RESULTSTwenty-nine patients undergoing 31 episodes of hypofractionated SBRT alone for grade 2 ESCC between 2014 and 2018 were identified. The 1-year and 2-year cumulative incidences of LRF were 10.4% (95% CI 0–21.9) and 22.0% (95% CI 5.5–38.4), respectively. The median survival was 9.81 months (95% CI 8.12–18.54). The 1-year cumulative incidence of SLS was 6.8% (95% CI 0–16.0) and the 2-year incidence of SLS was 14.5% (95% CI 0.6–28.4). All patients who progressed to requiring surgery had index lesions at the thoracic apex (T5–7).CONCLUSIONSIn carefully selected patients, treatment of grade 2 ESCC disease with hypofractionated SBRT alone offers a 1-year cumulative incidence of LRF similar to that in low-grade ESCC and postseparation surgery adjuvant hypofractionated SBRT. Use of SBRT alone has a favorable safety profile and a low cumulative incidence of progressive disease requiring open surgical intervention (14.5%).

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Section: Discussionmentioning

confidence: 99%

Hypofractionated spinal stereotactic body radiation therapy for high-grade epidural disease

Rothrock¹,

Lis

et al. 2020

Journal of Neurosurgery: Spine

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“…Some studies included comparison with polymetastatic disease of spine and compared outcomes, this was excluded when analyzing Kaplan Meier Curves or data tables. Only statistically significant data was chosen to make valid comparisons between Local Control or Overall Survival rates [7][8][9][10][11][12][13][14][15][16][17][18] .…”

Section: Methodsmentioning

confidence: 99%

Comparison of the Effectiveness of Stereotactic Radiosurgery for Spinal Oligometastatic Disease With Surgical and Conventional External Beam Radiotherapy Determined by Local Control, Overall Survival, Pain Response and Toxicities: A Systematic Review.

Saha¹,

Hamdan²,

Ajayi³

et al. 2020

BJSRG

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The aim of this study is to determine whether there is a benefit of using stereotactic radiosurgery (SRS) versus surgery or conventional external beam radiotherapy (cEBRT) for spinal oligometastatic disease in terms of tumor control, pain control, toxicity and morbidity. This systematic review was conducted by searching electronic databases such as Pubmed, Medline (Ovid) and Oxford Academic using an adapted version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) checklist. Retrospective and prospective studies were identified and investigated for methods of treatment such as SRS, surgery and radiotherapy of spinal oligometastatic disease. Local Control rates, Overall Survival (OS) rates, Pain Response (PR) and toxicities were extracted to be investigated and compared. A study eligibility criterion was made to ensure that results were valid, statistically significant and relevant to the investigation. One hundred and five articles were relevant to oligometastatic disease with the mention of spinal metastases however 89 of these articles were excluded based on irrelevance to investigation, title, abstract and duplication. Sixteen full text articles were thoroughly screened including 9 of them in the review. For 601 patients the average one year local control rate was 89%, average one year overall survival rate was 88%, evidence of pain relief was present, and some patients suffered low grade toxicities. In conclusion, stereotactic radiosurgery is an excellent modality of treatment of spinal oligometastatic disease as local control rates, overall survival rates, pain response and toxicities indicate improved outcomes in comparison to studies that investigated the same factors with the treatment of surgery or cEBRT. However, there is a lack of data here to make statistically valid claims and require more studies & data to be analyzed and compared.

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“…In a pair of Phase 1/2 studies of SABR using 60 Gy in three fractions, 2-year local control for patients with lung metastases was 96% 41 and for patients with liver metastases it was 92%. 42 In studies of spinal metastases, rates of local control are typically >80%; 43 , 44 however, tumours irradiated with higher doses can demonstrate much better local control. In a large retrospective experience analysing dosimetric parameters of 811 spinal tumours treated with single-fraction SABR, those treated with ‘high dose’ SABR with a median GTV D95 (dose to 95% of the gross tumour volume) of 23.56 Gy were found to have 4-year local control of 98%, whereas lesions in the ‘low dose’ group, defined as GTV D95 17.09 cGy, had approximately 80% 4-year local control.…”

Section: Local Therapy For Metastatic Diseasementioning

confidence: 99%

Metastasis-directed therapy for oligometastasis and beyond

et al. 2020

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Metastasis-directed therapy (MDT)-local therapy that is intended to eradicate specific metastatic lesions-has hitherto been used with varying degrees of clinical efficacy and acceptance as a meaningful therapy for metastatic disease. Over the past 25 years, however, the momentum for using MDT to manage patients with metastatic solid tumours has increased, driven by several factors. Among these factors is the recognition that patients with limited metastatic burden could potentially derive survival benefits from MDT. Furthermore, although current systemic therapies are increasingly effective, they are infrequently curative. In addition, technological advances have broadened the spectrum of metastatic lesions that can be treated with ablative intent. Here we aim to briefly review the status of evidence for the clinical benefit of MDT based on current data mainly from trials in patients with oligometastatic disease, discuss the myriad of clinical states that might fall under and beyond the definition of oligometastasis, review technological advances in MDT and their applications beyond oligometastasis, and discuss the need for the continued co-evolution of MDT and systemic therapy as we seek to understand which patients with metastatic cancer can achieve durable remission and how to optimally manage those who cannot.

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Oligometastatic Disease State Is Associated with Improved Local Control in Patients Undergoing Three or Five Fraction Spine Stereotactic Body Radiotherapy

Cited by 16 publications

References 36 publications

Hypofractionated spinal stereotactic body radiation therapy for high-grade epidural disease

Hypofractionated spinal stereotactic body radiation therapy for high-grade epidural disease

Comparison of the Effectiveness of Stereotactic Radiosurgery for Spinal Oligometastatic Disease With Surgical and Conventional External Beam Radiotherapy Determined by Local Control, Overall Survival, Pain Response and Toxicities: A Systematic Review.

Metastasis-directed therapy for oligometastasis and beyond

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