Outcomes and Toxicity for Hypofractionated and Single-Fraction Image-Guided Stereotactic Radiosurgery for Sarcomas Metastasizing to the Spine

Folkert, Michael R.; Bilsky, Mark H.; Tom, Ashlyn; Oh, Jung Hun; Alektiar, Kaled M.; Laufer, Ilya; Tap, William D.; Yamada, Yoshiya

doi:10.1016/j.ijrobp.2013.12.042

Cited by 131 publications

(87 citation statements)

References 27 publications

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“…The largest series of spinal sarcomas treated with SRS was reported by Folkert et al 12 In this study, 88 patients with 120 metastases were treated with either single-fraction (median dose 24 Gy) or hypofractionated (median dose 29 Gy, 3-6 fractions) radiosurgery. No symptomatic outcomes were reported.…”

Section: Radiographic Control After Irradiation Of Spinal Sarcomasmentioning

confidence: 99%

“…8,11 Given the radioresistant nature of sarcomas, fractionated doses exceeding 65 Gy are generally required for local control. 8,[12][13][14][15] Although these doses are feasible for extremity sarcomas, primary and metastatic spinal sarcomas pose a significant challenge given proximity to the spinal cord. As such, conventional external beam radiotherapy has historically offered poor durability of local control.…”

Section: Introductionmentioning

confidence: 99%

“…8,13,14,16 In contrast to conventional radiotherapy, spine stereotactic radiosurgery (SRS) delivers highly conformal radiotherapy in single-or hypofractionated regimens and may offer superior local control of spinal sarcomas. [12][13][14]17,18 Indeed, 1-year local control of sarcomas following SRS has been reported to range from 70% to 90% with single-fraction doses of 22 to 24 Gy. 12,14 However, there is a paucity of data reporting rates of pain relief following SRS for sarcomas.…”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14]17,18 Indeed, 1-year local control of sarcomas following SRS has been reported to range from 70% to 90% with single-fraction doses of 22 to 24 Gy. 12,14 However, there is a paucity of data reporting rates of pain relief following SRS for sarcomas. Accordingly, we sought to report rates of pain relief and progression following SRS using the Brief Pain Inventory (BPI).…”

Section: Introductionmentioning

confidence: 99%

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Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Spinal Sarcomas

Miller

Balagamwala

Angelov

et al. 2016

Technol Cancer Res Treat

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Purpose: Despite advancements in local and systemic therapy, metastasis remains common in the natural history of sarcomas. Unfortunately, such metastases are the most significant source of morbidity and mortality in this heterogeneous disease. As a classically radioresistant histology, stereotactic radiosurgery has emerged to control spinal sarcomas and provide palliation. However, there is a lack of data regarding pain relief and relapse following stereotactic radiosurgery. Methods: We queried a retrospective institutional database of patients who underwent spine stereotactic radiosurgery for primary and metastatic sarcomas. The primary outcome was pain relief following stereotactic radiosurgery. Secondary outcomes included progression of pain, radiographic failure, and development of toxicities following treatment. Results: Forty treatment sites were eligible for inclusion; the median prescription dose was 16 Gy in a single fraction. Median time to radiographic failure was 14 months. At 6 and 12 months, radiographic control was 63% and 51%, respectively. Among patients presenting with pain, median time to pain relief was 1 month. Actuarial pain relief at 6 months was 82%. Median time to pain progression was 10 months; at 12 months, actuarial pain progression was 51%. Following multivariate analysis, presence of neurologic deficit at consult (hazard ratio: 2.48, P < .01) and presence of extraspinal bone metastases (hazard ratio: 2.83, P < .01) were associated with pain relief. Greater pain at consult (hazard ratio: 1.92, P < .01), prior radiotherapy (hazard ratio: 4.65, P ¼ .02), and greater number of irradiated vertebral levels were associated with pain progression. Conclusions: Local treatment of spinal sarcomas has remained a challenge for decades, with poor rates of local control and limited pain relief following conventional radiotherapy. In this series, pain relief was achieved in 82% of treatments at 6 months, with half of patients experiencing pain progression by 12 months. Given minimal toxicity and suboptimal pain control at 12 months, dose escalation beyond 16 Gy is warranted.

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Section: Radiographic Control After Irradiation Of Spinal Sarcomasmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Spinal Sarcomas

Miller

Balagamwala

Angelov

et al. 2016

Technol Cancer Res Treat

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“…An apparent advantage for ultra-high single dose SBRT was recently reported by Folkert et al in patients treated for spine and para-spinal metastatic sarcoma. 21 Soft tissue and bone sarcomas are notoriously radio-resistant by classical radiobiological ranking, and conventional radiation treatment Gy at 2-5 Gy per fraction) is sub-curative, resulting in low rates of local control. In this series, 88 patients with 120 discrete metastases received hypofractionation (3-6 fractions; median dose, 28.5 Gy) or single fraction (median dose, 24 Gy).…”

Section: Rationale Of Single Dose Versus Hypofractionated Regimensmentioning

confidence: 99%

Spinal metastases: From conventional fractionated radiotherapy to single-dose SBRT

Greco

Parés

Pimentel

et al. 2015

Reports of Practical Oncology & Radiotherapy

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Full automation of spinal stereotactic radiosurgery and stereotactic body radiation therapy treatment planning using Varian Eclipse scripting

Teruel¹,

Malin²,

Liu³

et al. 2020

J Applied Clin Med Phys

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The purpose of this feasibility study is to develop a fully automated procedure capable of generating treatment plans with multiple fractionation schemes to improve speed, robustness, and standardization of plan quality. A fully automated script was implemented for spinal stereotactic radiosurgery/stereotactic body radiation therapy (SRS/SBRT) plan generation using Eclipse v15.6 API. The script interface allows multiple dose/fractionation plan requests, planning target volume (PTV) expansions, as well as information regarding distance/overlap between spinal cord and targets to drive decision‐making. For each requested plan, the script creates the course, plans, field arrangements, and automatically optimizes and calculates dose. The script was retrospectively applied to ten computed tomography (CT) scans of previous cervical, thoracic, and lumbar spine SBRT patients. Three plans were generated for each patient — simultaneous integrated boost (SIB) 1800/1600 cGy to gross tumor volume (GTV)/PTV in one fraction; SIB 2700/2100 cGy to GTV/PTV in three fractions; and 3000 cGy to PTV in five fractions. Plan complexity and deliverability patient‐specific quality assurance (QA) was performed using ArcCHECK with an Exradin A16 chamber inserted. Dose objectives were met for all organs at risk (OARs) for each treatment plan. Median target coverage was GTV V100% = 87.3%, clinical target volume (CTV) V100% = 95.7% and PTV V100% = 88.0% for single fraction plans; GTV V100% = 95.6, CTV V100% = 99.6% and PTV V100% = 97.2% for three fraction plans; and GTV V100% = 99.6%, CTV V100% = 99.1% and PTV V100% = 97.2% for five fraction plans. All plans (n = 30) passed patient‐specific QA (>90%) at 2%/2 mm global gamma. A16 chamber dose measured at isocenter agreed with planned dose within 3% for all cases. Automatic planning for spine SRS/SBRT through scripting increases efficiency, standardizes plan quality and approach, and provides a tool for target coverage comparison of different fractionation schemes without the need for additional resources.

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Outcomes and Toxicity for Hypofractionated and Single-Fraction Image-Guided Stereotactic Radiosurgery for Sarcomas Metastasizing to the Spine

Cited by 131 publications

References 27 publications

Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Spinal Sarcomas

Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Spinal Sarcomas

Spinal metastases: From conventional fractionated radiotherapy to single-dose SBRT

Full automation of spinal stereotactic radiosurgery and stereotactic body radiation therapy treatment planning using Varian Eclipse scripting

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