Spine stereotactic radiosurgery for metastatic sarcoma: patterns of failure and radiation treatment volume considerations
| Autor: | Randa Tao, Jing Li, Xin A. Wang, Claudio E. Tatsui, Paul D. Brown, Amol J. Ghia, Behrang Amini, Andrew J. Bishop, Pamela K. Allen, Eric L. Chang, Laurence D. Rhines, Neal Rebueno, B. Ashleigh Guadagnolo |
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| Rok vydání: | 2017 |
| Předmět: |
Leiomyosarcoma
Adult Male Adolescent medicine.medical_treatment Kaplan-Meier Estimate Radiosurgery 03 medical and health sciences Young Adult 0302 clinical medicine Recurrence Medicine Humans Treatment Failure Aged Aged 80 and over Spinal Neoplasms business.industry Soft tissue Histology Sarcoma General Medicine Middle Aged medicine.disease Acute toxicity Epidural space medicine.anatomical_structure 030220 oncology & carcinogenesis Toxicity Multivariate Analysis Female Neoplasm Recurrence Local business Nuclear medicine 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Journal of neurosurgery. Spine. 27(3) |
| ISSN: | 1547-5646 |
| Popis: | OBJECTIVEGiven the relatively lower radiosensitivity of sarcomas and the locally infiltrative patterns of spread, the authors sought to investigate spine stereotactic radiosurgery (SSRS) outcomes for metastatic sarcomas and to analyze patterns of failure.METHODSThe records of 48 patients with 66 sarcoma spinal metastases consecutively treated with SSRS between 2002 and 2013 were reviewed. The Kaplan-Meier method was used to estimate rates of overall survival (OS) and local control (LC). Local recurrences were categorized as occurring infield (within the 95% isodose line [IDL]), marginally (between the 20% and 95% IDLs), or out of field.RESULTSMedian follow-up time was 19 months (range 1–121 months), and median age was 53 years (range 17–85 years). The most commonly treated histology was leiomyosarcoma (42%). Approximately two-thirds of the patients were treated with definitive SSRS (44 [67%]) versus postoperatively (22 [33%]). The actuarial 1-year OS and LC rates were 67% and 81%, respectively. Eighteen patients had a local relapse, which was more significantly associated with postoperative SSRS (p = 0.04). On multivariate modeling, receipt of postoperative SSRS neared significance for poorer LC (p = 0.06, subhazard ratio [SHR] 2.33), while only 2 covariates emerged as significantly correlated with LC: 1) biological equivalent dose (BED) > 48 Gy (vs BED ≤ 48 Gy, p = 0.006, SHR 0.21) and 2) single vertebral body involvement (vs multiple bodies, p = 0.03, SHR 0.27). Of the 18 local recurrences, 14 (78%) occurred at the margin, and while the majority of these cases relapsed within the epidural space, 4 relapsed within the paraspinal soft tissue. In addition, 1 relapse occurred out of field. Finally, the most common acute toxicity was fatigue (15 cases), with few late toxicities (4 insufficiency fractures, 3 neuropathies).CONCLUSIONSFor metastatic sarcomas, SSRS provides durable tumor control with minimal toxicity. High-dose single-fraction regimens offer optimal LC, and given the infiltrative nature of sarcomas, when paraspinal soft tissues are involved, larger treatment volumes may be warranted. |
| Databáze: | OpenAIRE |
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