1. Stereotactic Body Radiation Therapy for Spinal Metastases in the Postoperative Setting: A Secondary Analysis of Mature Phase 1-2 Trials.
- Author
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Tao R, Bishop AJ, Brownlee Z, Allen PK, Settle SH, Chang EL, Wang X, Amini B, Tannir NM, Tatsui C, Rhines LD, Brown PD, and Ghia AJ
- Subjects
- Adult, Aged, Aged, 80 and over, Causality, Clinical Trials, Phase I as Topic statistics & numerical data, Clinical Trials, Phase II as Topic statistics & numerical data, Comorbidity, Female, Follow-Up Studies, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Postoperative Care, Prognosis, Radiotherapy, Adjuvant, Risk Factors, Spinal Neoplasms mortality, Survival Rate, Treatment Outcome, United States epidemiology, Nervous System Diseases mortality, Radiation Injuries mortality, Radiosurgery mortality, Spinal Cord Injuries mortality, Spinal Neoplasms radiotherapy, Spinal Neoplasms secondary
- Abstract
Purpose: To evaluate the outcomes in patients treated on prospective phase 1-2 protocols with postoperative stereotactic body radiation therapy (SBRT) and identify the associated prognostic variables., Methods and Materials: Sixty-six patients with 69 tumors were treated with SBRT on prospective phase 1-2 studies for spinal metastases between 2002 and 2010. All patients underwent SBRT after spine surgery, which included laminectomy, vertebrectomy, or a combination of these techniques. Renal cell carcinoma was the most common histology represented (n=35, 53%) followed by sarcomas (n=13, 20%). Thirty-one patients (47%) were treated with prior conventional radiation to the spine (median dose 30 Gy). Patients were followed up with spinal magnetic resonance imaging (MRI) studies to determine the treated tumor control (TC). Pain and other symptom data were collected prospectively to determine treatment response and toxicity., Results: The median follow-up time was 30 months (range, 1-145 months) for all patients and 75 months for living patients (range, 6-145 months). The actuarial 1-year rate of TC was 85%, adjacent vertebral body control was 85%, and overall survival (OS) was 74% (median 29 months). On multivariate competing-risks analysis, sarcoma histology (subhazard ratio [SHR] = 2.38, 95% confidence interval [CI] 1.05-5.6, P=.04) and larger preoperative tumor volumes (SHR=1.01, 95% CI 1.0-1.01, P=.006) were significantly associated with worse TC. Karnofsky performance status was the only significant predictor for OS on multivariate analysis. There were no differences in TC between patients treated with different surgical techniques or different preoperative or postoperative Bilsky grades. There were no grade 3 or higher neurologic toxicities., Conclusion: This study represents a large series of prospective data available on patients treated with SBRT in the postoperative setting. The combination of surgery with SBRT can offer patients with metastatic disease to the spine the chance of durable tumor control with minimal toxicity., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
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