Recursive Partitioning Analysis Index is Predictive for Overall Survival in Patients Undergoing Spine Stereotactic Body Radiation Therapy for Spinal Metastases

Chao, S.T.; Koyfman, Shlomo A.; Woody, N.M.; Angelov, L.; Soeder, S.; Reddy, C.A.; Rybicki, L. A.; Djemil, T.; Suh, Jung-Keun

doi:10.1016/j.ijrobp.2010.07.073

Cited by 13 publications

(24 citation statements)

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“…Survival-prediction models reported by both the Cleveland Clinic and MDACC might identify longer-term survivors, but their results remain to be validated on a larger scale. 4,27 Given the absence of randomized data, the question of who the optimal candidate is for spine SBRT is challenging. Patients ideally would be treated in a clinical trial.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for de novo spinal metastases: systematic review

Husain

Sahgal

Salles

et al. 2017

Journal of Neurosurgery: Spine

143

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OBJECTIVEThe aim of this systematic review was to provide an objective summary of the published literature pertaining to the use of stereotactic body radiation therapy (SBRT) specific to previously untreated spinal metastases.METHODSThe authors performed a systematic review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, of the literature found in a search of Medline, PubMed, Embase, and the Cochrane Library up to March 2015. The search strategy was limited to publications in the English language.RESULTSA total of 14 full-text articles were included in the analysis. All studies were retrospective except for 2 studies, which were prospective. A total of 1024 treated spinal lesions were analyzed. The median follow-up time ranged from 9 to 49 months. A range of dose-fractionation schemes was used, the most common of which were 16–24 Gy/1 fraction (fx), 24 Gy/2 fx, 24–27 Gy/3 fx, and 30–35 Gy/5 fx. In studies that reported crude results regarding in-field local tumor control, 346 (85%) of 407 lesions remained controlled. For studies that reported actuarial values, the weighted average revealed a 90% 1-year local control rate. Only 3 studies reported data on complete pain response, and the weighted average of these results yielded a complete pain response rate of 54%. The most common toxicity was new or progressing vertebral compression fracture, which was observed in 9.4% of cases; 2 cases (0.2%) of neurologic injury were reported.CONCLUSIONThere is a paucity of prospective data specific to SBRT in patients with spinal metastases not otherwise irradiated. This systematic review found that SBRT is associated with favorable rates of local control (approximately 90% at 1 year) and complete pain response (approximately 50%), and low rates of serious adverse events were found. Practice guidelines are summarized based on these data and International Stereotactic Radiosurgery Society consensus.

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Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for de novo spinal metastases: systematic review

Husain

Sahgal

Salles

et al. 2017

Journal of Neurosurgery: Spine

143

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“…alignancy involving the spinal column is extremely common, with more than 18,000 new cases of spinal metastases diagnosed in North America each year. 7,8,15 The role of stereotactic body radiation therapy (SBRT) has become well established in the treatment of primary and metastatic tumors of the spine. The term " stereotactic body radiation therapy" implies high-dose-per-fraction radiation (typically more than 5 Gy) delivered to an image-guided target in 1-5 fractions, using conformal radiation techniques.…”

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confidence: 99%

Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation

Jawad¹,

Fahim

Gerszten

et al. 2016

SPI

103

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OBJECTIVE The purpose of this study was to identify factors contributing to an increased risk for vertebral compression fracture (VCF) following stereotactic body radiation therapy (SBRT) for spinal tumors. METHODS A total of 594 tumors were treated with spinal SBRT as primary treatment or re-irradiation at 8 different institutions as part of a multi-institutional research consortium. Patients underwent LINAC-based, image-guided SBRT to a median dose of 20 Gy (range 8–40 Gy) in a median of 1 fraction (range 1–5 fractions). Median patient age was 62 years. Seventy-one percent of tumors were osteolytic, and a preexisting vertebral compression fracture (VCF) was present in 24% of cases. Toxicity was assessed following treatment. Univariate and multivariate analyses were performed using a logistic regression method to determine parameters predictive for post-SBRT VCF. RESULTS At a median follow-up of 10.1 months (range 0.03–57 months), 80% of patients had local tumor control. At the time of last imaging follow-up, at a median of 8.8 months after SBRT, 3% had a new VCF, and 2.7% had a progressive VCF. For development of any (new or progressive) VCF following SBRT, the following factors were predictive for VCF on univariate analysis: short interval from primary diagnosis to SBRT (less than 36.8 days), solitary metastasis, no additional bone metastases, no prior chemotherapy, preexisting VCF, no MRI used for target delineation, tumor volume of 37.3 cm3 or larger, equivalent 2-Gy-dose (EQD2) tumor of 41.8 Gy or more, and EQD2 spinal cord Dmax of 46.1 Gy or more. Preexisting VCF, solitary metastasis, and prescription dose of 38.4 Gy or more were predictive on multivariate analysis. The following factors were predictive of a new VCF on univariate analysis: solitary metastasis, no additional bone metastases, and no MRI used for target delineation. Presence of a solitary metastasis and lack of MRI for target delineation remained significant on multivariate analysis. CONCLUSIONS A VCF following SBRT is more likely to occur following treatment for a solitary spinal metastasis, reflecting a more aggressive treatment approach in patients with adequately controlled systemic disease. Higher prescription dose and a preexisting VCF also put patients at increased risk for post-SBRT VCF. In these patients, pre-SBRT cement augmentation could be considered to decrease the risk of subsequent VCF.

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“…Two prognostic scales exist in the literature aiming to define patients which may benefit from SBRT. The first prognostic index is a recursive partitioning analysis (RPA) regarding patients with spinal metastases undergoing SBRT (Chao et al., ). RPA stratifies patients per time from the primary diagnosis, Karnofsky performance status (KPS) and age into three classes associated with median overall survival (Table ).…”

Section: Resultsmentioning

confidence: 99%

The role of radiotherapy in bone metastases: A critical review of current literature

et al. 2017

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Radiotherapy is considered the treatment of choice for painful bone metastases. However, novel modalities of radiotherapy have emerged in the concept of oligometastasic disease. In addition, the increase of overall survival of patients with bone metastatic disease in the last decades due to systemic treatments has issued the silent topic of re-irradiation. The aim of this manuscript was to present a current thorough search of relevant literature. Originally, 6,087 articles revealed from PubMed database related to radiotherapy and bone metastases. The first objective was to identify prospective randomised phase III studies dealing with bone metastases and which treated primary with radiotherapy. Abstracts and non-English citations were excluded. Twenty-three phase III clinical trials, 17 prospective studies and eight meta-analysis/systemic reviews matching with these criteria, were identified. Eleven randomised studies were comparing single dose fraction to multi-fraction schedules of radiotherapy. The overall response rates and complete response rates were not significant between the two arms. Re-irradiations rates were significantly higher for the single dose fraction arms. Stereotactic radiotherapy showed excellent tumour control rates more than 80%. All trials showed the equivalence of either single or multi-fractionated radiotherapy for metastatic bone lesions. Stereotactic irradiation is feasible and safe for oligometastatic disease. However, it seems that the single fraction of 8 Gy is superior to 4 Gy, in terms of efficacy.

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Recursive Partitioning Analysis Index is Predictive for Overall Survival in Patients Undergoing Spine Stereotactic Body Radiation Therapy for Spinal Metastases

Cited by 13 publications

References 0 publications

Stereotactic body radiotherapy for de novo spinal metastases: systematic review

Stereotactic body radiotherapy for de novo spinal metastases: systematic review

Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation

The role of radiotherapy in bone metastases: A critical review of current literature

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