Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases
Purpose When patients show progression after conventional fractionated radiation for spine metastasis, further radiation and surgery may not be options. Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2011-12, Vol.81 (5), p.1500-1505 |
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| creator | Mahadevan, Anand, M.D Floyd, Scott, M.D., Ph.D Wong, Eric, M.D Jeyapalan, Suriya, M.D Groff, Michael, M.D Kasper, Ekkehard, M.D., Ph.D |
| description | Purpose When patients show progression after conventional fractionated radiation for spine metastasis, further radiation and surgery may not be options. Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use of SBRT for 60 consecutive patients (81 lesions) who had radiological progressive spine metastasis with epidural involvement after previous radiation for spine metastasis. Methods and Materials SBRT was used with fiducial and vertebral anatomy-based targeting. The radiation dose was prescribed based on the extent of spinal canal involvement; the dose was 8 Gy × 3 = 24 Gy when the tumor did not touch the spinal cord and 5 to 6 Gy x 5 = 25 to 30 Gy when the tumor abutted the cord. The cord surface received up to the prescription dose with no hot spots in the cord. Results The median overall survival was 11 months, and the median progression-free survival was 9 months. Overall, 93% of patients had stable or improved disease while 7% of patients showed disease progression; 65% of patients had pain relief. There was no significant toxicity other than fatigue. Conclusions SBRT is feasible and appears to be an effective treatment modality for reirradiation after conventional palliative radiation fails for spine metastasis patients. |
| doi_str_mv | 10.1016/j.ijrobp.2010.08.012 |
| format | Article |
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Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use of SBRT for 60 consecutive patients (81 lesions) who had radiological progressive spine metastasis with epidural involvement after previous radiation for spine metastasis. Methods and Materials SBRT was used with fiducial and vertebral anatomy-based targeting. The radiation dose was prescribed based on the extent of spinal canal involvement; the dose was 8 Gy × 3 = 24 Gy when the tumor did not touch the spinal cord and 5 to 6 Gy x 5 = 25 to 30 Gy when the tumor abutted the cord. The cord surface received up to the prescription dose with no hot spots in the cord. Results The median overall survival was 11 months, and the median progression-free survival was 9 months. Overall, 93% of patients had stable or improved disease while 7% of patients showed disease progression; 65% of patients had pain relief. There was no significant toxicity other than fatigue. Conclusions SBRT is feasible and appears to be an effective treatment modality for reirradiation after conventional palliative radiation fails for spine metastasis patients.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2010.08.012</identifier><identifier>PMID: 20950944</identifier><identifier>CODEN: IOBPD3</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Diseases of the nervous system ; FATIGUE ; Female ; Fiducial Markers ; Hematology, Oncology and Palliative Medicine ; Humans ; Male ; Medical sciences ; METASTASES ; Middle Aged ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - surgery ; NEOPLASMS ; PAIN ; PATIENTS ; RADIATION DOSES ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; Radiosurgery - methods ; RADIOTHERAPY ; Radiotherapy Dosage ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Reirradiation ; Retrospective Studies ; SPINAL CORD ; Spinal Cord Neoplasms - mortality ; Spinal Cord Neoplasms - secondary ; Spinal Cord Neoplasms - surgery ; Spinal metastases ; Spinal Neoplasms - mortality ; Spinal Neoplasms - radiotherapy ; Spinal Neoplasms - secondary ; Spinal Neoplasms - surgery ; Stereotactic body radiotherapy ; Stereotactic radiosurgery ; SURFACES ; SURGERY ; Therapeutics - methods ; TOXICITY ; VERTEBRAE</subject><ispartof>International journal of radiation oncology, biology, physics, 2011-12, Vol.81 (5), p.1500-1505</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c573t-3239138b91b424a6097f8bfcf3215f82481e201946a8ad532e1e2dee75341b063</citedby><cites>FETCH-LOGICAL-c573t-3239138b91b424a6097f8bfcf3215f82481e201946a8ad532e1e2dee75341b063</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2010.08.012$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,777,781,882,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25274278$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20950944$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22054519$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Mahadevan, Anand, M.D</creatorcontrib><creatorcontrib>Floyd, Scott, M.D., Ph.D</creatorcontrib><creatorcontrib>Wong, Eric, M.D</creatorcontrib><creatorcontrib>Jeyapalan, Suriya, M.D</creatorcontrib><creatorcontrib>Groff, Michael, M.D</creatorcontrib><creatorcontrib>Kasper, Ekkehard, M.D., Ph.D</creatorcontrib><title>Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose When patients show progression after conventional fractionated radiation for spine metastasis, further radiation and surgery may not be options. Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use of SBRT for 60 consecutive patients (81 lesions) who had radiological progressive spine metastasis with epidural involvement after previous radiation for spine metastasis. Methods and Materials SBRT was used with fiducial and vertebral anatomy-based targeting. The radiation dose was prescribed based on the extent of spinal canal involvement; the dose was 8 Gy × 3 = 24 Gy when the tumor did not touch the spinal cord and 5 to 6 Gy x 5 = 25 to 30 Gy when the tumor abutted the cord. The cord surface received up to the prescription dose with no hot spots in the cord. Results The median overall survival was 11 months, and the median progression-free survival was 9 months. Overall, 93% of patients had stable or improved disease while 7% of patients showed disease progression; 65% of patients had pain relief. There was no significant toxicity other than fatigue. Conclusions SBRT is feasible and appears to be an effective treatment modality for reirradiation after conventional palliative radiation fails for spine metastasis patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Diseases of the nervous system</subject><subject>FATIGUE</subject><subject>Female</subject><subject>Fiducial Markers</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>METASTASES</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - mortality</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>NEOPLASMS</subject><subject>PAIN</subject><subject>PATIENTS</subject><subject>RADIATION DOSES</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Radiosurgery - methods</subject><subject>RADIOTHERAPY</subject><subject>Radiotherapy Dosage</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Reirradiation</subject><subject>Retrospective Studies</subject><subject>SPINAL CORD</subject><subject>Spinal Cord Neoplasms - mortality</subject><subject>Spinal Cord Neoplasms - secondary</subject><subject>Spinal Cord Neoplasms - surgery</subject><subject>Spinal metastases</subject><subject>Spinal Neoplasms - mortality</subject><subject>Spinal Neoplasms - radiotherapy</subject><subject>Spinal Neoplasms - secondary</subject><subject>Spinal Neoplasms - surgery</subject><subject>Stereotactic body radiotherapy</subject><subject>Stereotactic radiosurgery</subject><subject>SURFACES</subject><subject>SURGERY</subject><subject>Therapeutics - methods</subject><subject>TOXICITY</subject><subject>VERTEBRAE</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkl2L1TAQhoMo7nH1H4gURPCmx3y26Y2gy_oBK4LHBe9Cmk7Z1J6mJqlw_r1TelTwRggMMzyZyftmCHnK6J5RVr0a9n6IoZ33nGKJ6j1l_B7ZMV03pVDq232yo6KipUD4gjxKaaCUMlbLh-SC00bRRsoduT1kiBCyddm74m3oTsUX2_mQ7yDaGRPwMWLBZh-mog8RK26JEaZcXM--W6Idi8PsJwyfINuEB9Jj8qC3Y4In53hJbt9df736UN58fv_x6s1N6VQtcim4aJjQbcNayaWtaFP3uu1dLzhTveZSM0B1jaystp0SHDDvAGolJGtpJS7J861vSNmb5HwGd-fCNIHLhnOqpGINUi83ao7hxwIpm6NPDsbRThCWZJhQVcOVFhJRuaEuhpQi9GaO_mjjyTBqVtvNYDbbzWq7odqg7Xjt2XnC0h6h-3Ppt88IvDgDNjk79tFOzqe_nOK15LVG7vXGAbr200NcRcHkoPNx1dQF_7-X_NvAjX7yOPM7nCANYYn4VajZJG6oOawrsm4IoxiUpuIXgl62BQ</recordid><startdate>20111201</startdate><enddate>20111201</enddate><creator>Mahadevan, Anand, M.D</creator><creator>Floyd, Scott, M.D., Ph.D</creator><creator>Wong, Eric, M.D</creator><creator>Jeyapalan, Suriya, M.D</creator><creator>Groff, Michael, M.D</creator><creator>Kasper, Ekkehard, M.D., Ph.D</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U7</scope><scope>C1K</scope><scope>OTOTI</scope></search><sort><creationdate>20111201</creationdate><title>Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases</title><author>Mahadevan, Anand, M.D ; Floyd, Scott, M.D., Ph.D ; Wong, Eric, M.D ; Jeyapalan, Suriya, M.D ; Groff, Michael, M.D ; Kasper, Ekkehard, M.D., Ph.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c573t-3239138b91b424a6097f8bfcf3215f82481e201946a8ad532e1e2dee75341b063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Diseases of the nervous system</topic><topic>FATIGUE</topic><topic>Female</topic><topic>Fiducial Markers</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>METASTASES</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - mortality</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>NEOPLASMS</topic><topic>PAIN</topic><topic>PATIENTS</topic><topic>RADIATION DOSES</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Radiosurgery - methods</topic><topic>RADIOTHERAPY</topic><topic>Radiotherapy Dosage</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Reirradiation</topic><topic>Retrospective Studies</topic><topic>SPINAL CORD</topic><topic>Spinal Cord Neoplasms - mortality</topic><topic>Spinal Cord Neoplasms - secondary</topic><topic>Spinal Cord Neoplasms - surgery</topic><topic>Spinal metastases</topic><topic>Spinal Neoplasms - mortality</topic><topic>Spinal Neoplasms - radiotherapy</topic><topic>Spinal Neoplasms - secondary</topic><topic>Spinal Neoplasms - surgery</topic><topic>Stereotactic body radiotherapy</topic><topic>Stereotactic radiosurgery</topic><topic>SURFACES</topic><topic>SURGERY</topic><topic>Therapeutics - methods</topic><topic>TOXICITY</topic><topic>VERTEBRAE</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mahadevan, Anand, M.D</creatorcontrib><creatorcontrib>Floyd, Scott, M.D., Ph.D</creatorcontrib><creatorcontrib>Wong, Eric, M.D</creatorcontrib><creatorcontrib>Jeyapalan, Suriya, M.D</creatorcontrib><creatorcontrib>Groff, Michael, M.D</creatorcontrib><creatorcontrib>Kasper, Ekkehard, M.D., Ph.D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mahadevan, Anand, M.D</au><au>Floyd, Scott, M.D., Ph.D</au><au>Wong, Eric, M.D</au><au>Jeyapalan, Suriya, M.D</au><au>Groff, Michael, M.D</au><au>Kasper, Ekkehard, M.D., Ph.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2011-12-01</date><risdate>2011</risdate><volume>81</volume><issue>5</issue><spage>1500</spage><epage>1505</epage><pages>1500-1505</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><coden>IOBPD3</coden><abstract>Purpose When patients show progression after conventional fractionated radiation for spine metastasis, further radiation and surgery may not be options. Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use of SBRT for 60 consecutive patients (81 lesions) who had radiological progressive spine metastasis with epidural involvement after previous radiation for spine metastasis. Methods and Materials SBRT was used with fiducial and vertebral anatomy-based targeting. The radiation dose was prescribed based on the extent of spinal canal involvement; the dose was 8 Gy × 3 = 24 Gy when the tumor did not touch the spinal cord and 5 to 6 Gy x 5 = 25 to 30 Gy when the tumor abutted the cord. The cord surface received up to the prescription dose with no hot spots in the cord. Results The median overall survival was 11 months, and the median progression-free survival was 9 months. Overall, 93% of patients had stable or improved disease while 7% of patients showed disease progression; 65% of patients had pain relief. There was no significant toxicity other than fatigue. Conclusions SBRT is feasible and appears to be an effective treatment modality for reirradiation after conventional palliative radiation fails for spine metastasis patients.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20950944</pmid><doi>10.1016/j.ijrobp.2010.08.012</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Diseases of the nervous system FATIGUE Female Fiducial Markers Hematology, Oncology and Palliative Medicine Humans Male Medical sciences METASTASES Middle Aged Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - surgery NEOPLASMS PAIN PATIENTS RADIATION DOSES Radiology RADIOLOGY AND NUCLEAR MEDICINE Radiosurgery - methods RADIOTHERAPY Radiotherapy Dosage Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Reirradiation Retrospective Studies SPINAL CORD Spinal Cord Neoplasms - mortality Spinal Cord Neoplasms - secondary Spinal Cord Neoplasms - surgery Spinal metastases Spinal Neoplasms - mortality Spinal Neoplasms - radiotherapy Spinal Neoplasms - secondary Spinal Neoplasms - surgery Stereotactic body radiotherapy Stereotactic radiosurgery SURFACES SURGERY Therapeutics - methods TOXICITY VERTEBRAE |
| title | Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases |
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