| Autor: |
Khaled Dibs, Dukagjin M. Blakaj, Rahul N. Prasad, Alexander Olausson, Eric C. Bourekas, Daniel Boulter, Ahmet S. Ayan, Eric Cochran, William S. Marras, Prasath Mageswaran, Evan Thomas, Hyeri Lee, John Grecula, Raju R. Raval, Ehud Mendel, Thomas Scharschmidt, Russell Lonser, Arnab Chakravarti, James B. Elder, Joshua D. Palmer |
| Jazyk: |
angličtina |
| Rok vydání: |
2022 |
| Předmět: |
|
| Zdroj: |
Frontiers in Oncology, Vol 12 (2022) |
| Druh dokumentu: |
article |
| ISSN: |
2234-943X |
| DOI: |
10.3389/fonc.2022.912804 |
| Popis: |
BackgroundWith survival improving in many metastatic malignancies, spine metastases have increasingly become a source of significant morbidity; achieving durable local control (LC) is critical. Stereotactic body radiotherapy (SBRT) may offer improved LC and/or symptom palliation. However, due to setup concerns, SBRT is infrequently offered to patients with ≥3 contiguous involved levels. Because data are limited, we sought to evaluate the feasibility, toxicity, and cancer control outcomes of spine SBRT delivered to ≥3 contiguous levels.MethodsWe retrospectively identified all SBRT courses delivered between 2013 and 2019 at a tertiary care institution for postoperative or intact spine metastases. Radiotherapy was delivered to 14–35 Gy in 1–5 fractions. Patients were stratified by whether they received SBRT to 1–2 or ≥3 contiguous levels. The primary endpoint was 1-year LC and was compared between groups. Factors associated with increased likelihood of local failure (LF) were explored. Acute and chronic toxicity was assessed. In-depth dosimetric data were collected.ResultsOverall, 165 patients with 194 SBRT courses were identified [54% were men, median age was 61 years, 93% had Karnofsky Performance Status (KPS) ≥70, and median follow-up was 15 months]. One hundred thirteen patients (68%) received treatment to 1–2 and 52 to 3–7 (32%) levels. The 1-year LC was 88% (89% for 1–2 levels vs. 84% for ≥3 levels, p = 0.747). On multivariate analysis, uncontrolled systemic disease was associated with inferior LC for patients with ≥3 treated levels. No other demographic, disease, treatment, or dosimetric variables achieved significance. Rates of new/progressive fracture were equivalent (8% vs. 9.5%, p = 0.839). There were no radiation-induced myelopathy or grade 3+ acute or late toxicities in either group. Coverage of ≥95% of the planning target volume with ≥95% prescription dose was similar between groups (96% 1–2 levels vs. 89% ≥3 levels, p = 0.078).ConclusionsFor patients with ≥3 contiguous involved levels, spine SBRT is feasible and may offer excellent LC without significant toxicity. Prospective evaluation is warranted. |
| Databáze: |
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| Externí odkaz: |
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