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Title: Stereotactic Body Radiation Therapy for Spinal Metastases in the Postoperative Setting: A Secondary Analysis of Mature Phase 1-2 Trials

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 withmore » 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.« less

Authors:
; ; ; ;  [1];  [2];  [1];  [3];  [4]; ;  [5];  [1];  [1]
  1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  2. Department of Radiation Oncology, USC Norris Cancer Hospital, Keck School of Medicine of USC, Los Angeles, California (United States)
  3. Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  4. Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  5. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
Publication Date:
OSTI Identifier:
22648759
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 95; Journal Issue: 5; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; GY RANGE 10-100; MULTIVARIATE ANALYSIS; NMR IMAGING; PATIENTS; RADIATION HAZARDS; RADIOTHERAPY; SARCOMAS; SURGERY; TOXICITY; VERTEBRAE

Citation Formats

Tao, Randa, Bishop, Andrew J., Brownlee, Zachary, Allen, Pamela K., Settle, Stephen H., Chang, Eric L., Wang, Xin, Amini, Behrang, Tannir, Nizar M., Tatsui, Claudio, Rhines, Laurence D., Brown, Paul D., and Ghia, Amol J., E-mail: ajghia@mdanderson.org. Stereotactic Body Radiation Therapy for Spinal Metastases in the Postoperative Setting: A Secondary Analysis of Mature Phase 1-2 Trials. United States: N. p., 2016. Web. doi:10.1016/J.IJROBP.2016.03.022.
Tao, Randa, Bishop, Andrew J., Brownlee, Zachary, Allen, Pamela K., Settle, Stephen H., Chang, Eric L., Wang, Xin, Amini, Behrang, Tannir, Nizar M., Tatsui, Claudio, Rhines, Laurence D., Brown, Paul D., & Ghia, Amol J., E-mail: ajghia@mdanderson.org. Stereotactic Body Radiation Therapy for Spinal Metastases in the Postoperative Setting: A Secondary Analysis of Mature Phase 1-2 Trials. United States. doi:10.1016/J.IJROBP.2016.03.022.
Tao, Randa, Bishop, Andrew J., Brownlee, Zachary, Allen, Pamela K., Settle, Stephen H., Chang, Eric L., Wang, Xin, Amini, Behrang, Tannir, Nizar M., Tatsui, Claudio, Rhines, Laurence D., Brown, Paul D., and Ghia, Amol J., E-mail: ajghia@mdanderson.org. Mon . "Stereotactic Body Radiation Therapy for Spinal Metastases in the Postoperative Setting: A Secondary Analysis of Mature Phase 1-2 Trials". United States. doi:10.1016/J.IJROBP.2016.03.022.
@article{osti_22648759,
title = {Stereotactic Body Radiation Therapy for Spinal Metastases in the Postoperative Setting: A Secondary Analysis of Mature Phase 1-2 Trials},
author = {Tao, Randa and Bishop, Andrew J. and Brownlee, Zachary and Allen, Pamela K. and Settle, Stephen H. and Chang, Eric L. and Wang, Xin and Amini, Behrang and Tannir, Nizar M. and Tatsui, Claudio and Rhines, Laurence D. and Brown, Paul D. and Ghia, Amol J., E-mail: ajghia@mdanderson.org},
abstractNote = {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.},
doi = {10.1016/J.IJROBP.2016.03.022},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 95,
place = {United States},
year = {Mon Aug 01 00:00:00 EDT 2016},
month = {Mon Aug 01 00:00:00 EDT 2016}
}