Single‐fraction radiosurgery for the treatment of spinal breast metastases

Abstract

BACKGROUNDThe spine is the most common site of bony metastases in patients with osseous breast carcinoma metastases. Spine metastases are the source of significant pain and occasionally neurologic deficit in this patient population. Conventional external beam radiotherapy lacks the precision to allow delivery of large single‐fraction doses of radiation and simultaneously limit the dose to radiosensitive structures such as the spinal cord. This study evaluated the clinical efficacy of the treatment of spinal breast carcinoma metastases with a single‐fraction radiosurgical technique.METHODSIn this prospective cohort evaluation, 68 breast carcinoma metastases to the spine in 50 patients were treated with a single‐fraction radiosurgery technique with a follow‐up period of 6–48 months, median 16 months. The most common indication for radiosurgery treatment was pain in 57 lesions, as a primary treatment modality in 8 patients, and for radiographic tumor progression, as a postsurgical boost, and for a progressive neurologic deficit in 1 patient each.RESULTSTumor volume ranged from 0.8–197 cm3 (mean, 27.7 cm3). Maximum tumor dose was maintained at 15–22.5 Gy (mean, 19 Gy). No radiation‐induced toxicity occurred during the follow‐up period (6–48 mo). Long‐term axial and radicular pain improvement occurred in 55 of 57 (96%) patients who were treated primarily for pain. Long‐term radiographic tumor control was seen in all patients who underwent radiosurgery as their primary treatment modality, for radiographic tumor progression, or as a postsurgical treatment.CONCLUSIONSSpinal radiosurgery was found to be feasible, safe, and clinically effective for the treatment of spinal metastases from breast carcinoma. The results indicate the potential of radiosurgery in the treatment of patients with spinal breast metastases, especially those with solitary sites of spine involvement, to improve long‐term palliation. Cancer 2005. © 2005 American Cancer Society.

RTOG 0631 Phase II/III Study of Image-guided Stereotactic Radiosurgery for Localized Spine Metastases: Phase II Results

“…Clinical experience with single high dose SRS for spinal metastases demonstrated both safety and efficacy (6)(7)(8)(9)(10). Median time to pain relief was within 2 weeks, and there was durable pain contorl in 80-90%.…”

Submillimeter alignment of more than three contiguous vertebrae in spinal SRS/SBRT with 6‐degree couch

“…The risks of radiation myelopathy in spinal SRS/SBRT were very well studied6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 with Dmax been generally accepted as the parameter of dosimetric constraint. Kirkpatrick et al summarized nine published reports of spinal cord dose and myelopathy in 1,400 patients who received spinal SRS/SBRT 16.…”

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

“…Ninety-six percent of 68 spinal lesions in 50 breast cancer patients experienced pain relief (mean 5 points on the visual scale) at a median follow-up of 16 months (range 6-48), with no apparent acute or sub-acute neurological toxicity. 28 Similarly, long-term pain improvement and no acute or sub-acute neurological toxicities were reported in 77 lung cancer patients. 29 The majority of tumors in this series were non-small cell cancers (79/87, 91%), and 80% (70/87) received re-irradiation of lesions relapsing after previous conventional low dose radiotherapy.…”