Radiosurgery for Spinal Metastases

Gerszten, Peter C.; Burton, Steven A.; Ozhasoglu, Cihat; Welch, William C.

doi:10.1097/01.brs.0000251863.76595.a2

Cited by 666 publications

(178 citation statements)

References 48 publications

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“…Certainly, few sarcomas have been treated with SRS, and no prospective data exist to date regarding the general efficacy of spine SRS upon pain relief and radiographic control. 19,35 Attempts to limit bias included utilization of multivariate modeling to control for confounding associated with outcome variables. We also collected BPIs prospectively and longitudinally.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

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: Limitations and Strengthsmentioning

confidence: 99%

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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“…The rationale for SAbR of the spine is demonstrated in excellent pain control, bone marrow sparing in adjacent vertebrae, and a conventional, short treatment course and recovery time 1 , 2 , 3 , 4 , 5 , 6 . With ablative dose delivery, treatment efficacy is balanced with dose‐related toxicity to the spinal cord, requiring a sharp dose gradient outside the target region.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of Acuros XB with collapsed cone convolution/superposition and anisotropic analytic algorithm for stereotactic ablative radiotherapy of thoracic spinal metastases

Zhen

Hrycushko

Lee

et al. 2015

J Applied Clin Med Phys

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The aim of this study is to compare the recent Eclipse Acuros XB (AXB) dose calculation engine with the Pinnacle collapsed cone convolution/superposition (CCC) dose calculation algorithm and the Eclipse anisotropic analytic algorithm (AAA) for stereotactic ablative radiotherapy (SAbR) treatment planning of thoracic spinal (T‐spine) metastases using IMRT and VMAT delivery techniques. The three commissioned dose engines (CCC, AAA, and AXB) were validated with ion chamber and EBT2 film measurements utilizing a heterogeneous slab‐geometry water phantom and an anthropomorphic phantom. Step‐and‐shoot IMRT and VMAT treatment plans were developed and optimized for eight patients in Pinnacle, following our institutional SAbR protocol for spinal metastases. The CCC algorithm, with heterogeneity corrections, was used for dose calculations. These plans were then exported to Eclipse and recalculated using the AAA and AXB dose calculation algorithms. Various dosimetric parameters calculated with CCC and AAA were compared to that of the AXB calculations. In regions receiving above 50% of prescription dose, the calculated CCC mean dose is 3.1%–4.1% higher than that of AXB calculations for IMRT plans and 2.8%–3.5% higher for VMAT plans, while the calculated AAA mean dose is 1.5%–2.4% lower for IMRT and 1.2%–1.6% lower for VMAT. Statistically significant differences (p<0.05) were observed for most GTV and PTV indices between the CCC and AXB calculations for IMRT and VMAT, while differences between the AAA and AXB calculations were not statistically significant. For T‐spine SAbR treatment planning, the CCC calculations give a statistically significant overestimation of target dose compared to AXB. AAA underestimates target dose with no statistical significance compared to AXB. Further study is needed to determine the clinical impact of these findings.PACS number: 87.55.D‐, 87.53.Ly

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“…It has been extensively described elsewhere 17. CK is a commonly used modality to treat spine‐based metastasis due to its highly conformal dose distributions, steep gradient, and near real‐time image‐guidance system 18, 19, 20, 21, 22…”

Section: Introductionmentioning

confidence: 99%

Comparison of four techniques for spine stereotactic body radiotherapy: Dosimetric and efficiency analysis

Aljabab

Vellayappan

Vandervoort

et al. 2018

J Applied Clin Med Phys

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PurposeThe aim of this study is to compare the dosimetric differences between four techniques for spine stereotactic body radiotherapy (SBRT): CyberKnife (CK), volumetric modulated arc therapy (VMAT), and helical tomotherapy (HT) with dynamic jaws (HT‐D) and fixed jaws (HT‐F).Materials/methodsData from 10 patients were utilized. All patients were planned for 24 Gy in two fractions, with the primary objectives being: (a) restricting the maximum dose to the cord to ≤ 17 Gy and/or cauda equina to ≤ 20 Gy, and (b) to maximize the clinical target volume (CTV) to receive the prescribed dose. Treatment plans were generated by separate dosimetrists and then compared using velocity AI. Parameters of comparison include target volume coverage, conformity index (CI), gradient index (GI), homogeneity index (HI), treatment time (TT) per fraction, and monitor units (MU) per fraction.Results PTV D2 and D5 were significantly higher for CK compared to VMAT, HT‐F, and HT‐D (P < 0.001). The average volume of CTV receiving the prescription dose (CTV D95) was significantly less for VMAT compared to CK, HT‐F and HT‐D (P = 0.036). CI improved for CK (0.69), HT‐F (0.66), and HT‐D (0.67) compared to VMAT (0.52) (P = 0.013). CK (41.86) had the largest HI compared to VMAT (26.99), HT‐F (20.69), and HT‐D (21.17) (P < 0.001). GI was significantly less for CK (3.96) compared to VMAT (6.76) (P = 0.001). Likewise, CK (62.4 min, 14059 MU) had the longest treatment time and MU per fraction compared to VMAT (8.5 min, 9764 MU), HT‐F (13 min, 10822 MU), and HT‐D (13.5 min, 11418 MU) (P < 0.001).ConclusionBoth CK and HT plans achieved conformal target coverage while respecting cord tolerance. Dose heterogeneity was significantly larger in CK. VMAT required the least treatment time and MU output, but had the least steep GI, CI, and target coverage.

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Radiosurgery for Spinal Metastases

Abstract: The results indicate the potential of radiosurgery in the treatment of patients with spinal metastases, especially those with solitary sites of spine involvement, to improve long-term palliation.

Cited by 666 publications

References 48 publications

Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Spinal Sarcomas

Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Spinal Sarcomas

Dosimetric comparison of Acuros XB with collapsed cone convolution/superposition and anisotropic analytic algorithm for stereotactic ablative radiotherapy of thoracic spinal metastases

Comparison of four techniques for spine stereotactic body radiotherapy: Dosimetric and efficiency analysis

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