Stereotactic Body Radiation Therapy With Simultaneous Integrated Boost in Patients With Spinal Metastases

Abstract

Stereotactic body radiation therapy in patients with spine metastases maximizes local tumor control and preserves neurologic function. A novel approach could be the use of stereotactic body radiation therapy with simultaneous integrated boost delivering modality. The aim of the present study is to report our experience in the treatment of spine metastases using a frameless radiosurgery system delivering stereotactic body radiation therapy–simultaneous integrated boost technique. The primary endpoints were the pain control and the time to local progression; the secondary ones were the overall survival and toxicity. A total of 20 patients with spine metastases and 22 metastatic sites were treated in our center with stereotactic body radiation therapy–simultaneous integrated boost between December 2007 and July 2018. Stereotactic body radiation therapy–simultaneous integrated boost treatments were delivered doses of 8 to 10 Gy in 1 fraction to isodose line of 50%. The median follow-up was 35 months (range: 12-110). The median time to local progression for all patients was not reached and the actuarial 1-, 2-, and 3-years local free progression rate was 86.36%. In 17 of 20 patients, a complete pain remission was observed and 3 of 20 patients had a partial pain remission (complete pain remission + partial pain remission: 100%). The median overall survival was 38 months (range 12-83). None of the patients experienced neither radiation adverse events (grade 1-4) nor reported pain flair reaction. None of the patients included in our series experienced vertebral compression fracture. Spine radiosurgery with stereotactic body radiation therapy–simultaneous integrated boost is safe. The use of this modality in spine metastases patients provides an excellent local control.

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

“…Some risk for adverse events is peculiar to the stereotactic technique, which is an approach effectively used also in other metastatic or primary sites [41] , [42] , [43] , [44] in order to prevent the characteristic side effects of less conformal types of external beam radiotherapy [45] , [46] ; this therapeutic option allows to use a high radiation dose in a single fraction or short fractionated radiotherapy schedule. Kano et al [47] conducted a retrospective study involving 755 patients who have been submitted to a median single radiosurgery dose of 20 Gy.…”

Radiotherapy in Current Neuro-Oncology: There Is Still Much to Reveal

“…Such a key point is of fundamental importance not only in the cerebral region but also in other neuroaxis-related sites; for example, any damage to the vertebral column could be life-altering. The risk for vertebral compression fracture is especially feared when treating bone metastases to the vertebral body with high radiation doses [9].…”

Orbital Metastases: A Systematic Review of Clinical Characteristics, Management Strategies, and Treatment Outcomes

“…In line with previous reports on choroidal metastases, we also found that radiotherapy significantly ameliorates clinical and functional status in patients with orbital metastases ( p = 0.032), favoring nonsurgical lesion shrinkage and relief of mass effect [ 22 , 54 ]. Although some cases of radiation-induced cataracts have been reported in earlier studies [ 55 ], modern image-guided radiotherapy planning allows the delivery of maximal doses to selected targets [ 56 , 57 ], sparing critical orbital structures and preventing the onset of severe adverse events [ 55 , 58 , 59 , 60 ]. Thus, radiotherapy appears to be safe and effective in the treatment of orbital metastases similarly to choroidal metastases, but the severity of radiation-induced complications might differ due to the unfortunate proximity of choroidal metastases to the macula and lens [ 54 , 61 ].…”