Salvage Stereotactic Body Radiotherapy (SBRT) Following In-Field Failure of Initial SBRT for Spinal Metastases
Purpose We report our experience in salvaging spinal metastases initially irradiated with stereotactic body radiation therapy (SBRT), who subsequently progressed with imaging-confirmed local tumor progression, and were re-irradiated with a salvage second SBRT course to the same level. Methods and Ma...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2015-10, Vol.93 (2), p.353-360 |
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| creator | Thibault, Isabelle, MD Campbell, Mikki, MRT(T) Tseng, Chia-Lin, MD Atenafu, Eshetu G., MSc Letourneau, Daniel, PhD Yu, Eugene, MD Cho, B.C. John, MD Lee, Young K., PhD Fehlings, Michael G., MD, PhD Sahgal, Arjun, MD |
| description | Purpose We report our experience in salvaging spinal metastases initially irradiated with stereotactic body radiation therapy (SBRT), who subsequently progressed with imaging-confirmed local tumor progression, and were re-irradiated with a salvage second SBRT course to the same level. Methods and Materials From a prospective database, 56 metastatic spinal segments in 40 patients were identified as having been irradiated with a salvage second SBRT course to the same level. In addition, 24 of 56 (42.9%) segments had initially been irradiated with conventional external beam radiation therapy before the first course of SBRT. Local control (LC) was defined as no progression on magnetic resonance imaging at the treated segment, and calculated according to the competing risk model. Overall survival (OS) was evaluated for each patient treated by use of the Kaplan-Meier method. Results The median salvage second SBRT total dose and number of fractions was 30 Gy in 4 fractions (range, 20-35 Gy in 2-5 fractions), and for the first course of SBRT was 24 Gy in 2 fractions (range, 20-35 Gy in 1-5 fractions). The median follow-up time after salvage second SBRT was 6.8 months (range, 0.9-39 months), the median OS was 10.0 months, and the 1-year OS rate was 48%. A longer time interval between the first and second SBRT courses predicted for better OS ( P =.02). The crude LC was 77% (43/56), the 1-year LC rate was 81%, and the median time to local failure was 3.0 months (range, 2.7-16.7 months). Of the 13 local failures, 85% (11/13) and 46% (6/13) showed progression within the epidural space and paraspinal soft tissues, respectively. Absence of baseline paraspinal disease predicted for better LC ( P |
| doi_str_mv | 10.1016/j.ijrobp.2015.03.029 |
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| fullrecord | <record><control><sourceid>proquest_osti_</sourceid><recordid>TN_cdi_osti_scitechconnect_22458782</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0360301615003508</els_id><sourcerecordid>1713944346</sourcerecordid><originalsourceid>FETCH-LOGICAL-c511t-86707789cc794290d80f83b5a89e032dec21ccbec00aeb851576c94e2551df8a3</originalsourceid><addsrcrecordid>eNqFks9rFDEUgAdR7Fr9D0QCXuph1pdkMpO5CLa4WqgInQreQjbzps2anWyTTGX_ezNM9eBFCISE7_1IvlcUrymsKdD6_W5td8FvD2sGVKyBr4G1T4oVlU1bciF-PC1WwGsoeYZPihcx7gCA0qZ6XpywmkteS1gVY6fdg75F0iUM6JM2yRpy7vsjuda99ekOgz4cyVl3fn3zjmy8c_6XHW_J5VhuLLqebLR1U0Dih3xnk9WOzCwZfCDdwY75_BWTjnlhfFk8G7SL-OpxPy2-bz7dXHwpr759vrz4eFUaQWkqZd1A08jWmKatWAu9hEHyrdCyReCsR8OoMVs0ABq3UlDR1KatkAlB-0Fqflq8XfL6mKyKxiY0d8aPI5qkGKuEbCTL1NlCHYK_nzAmtbfRoHN6RD9FRRvK26riVZ3RakFN8DEGHNQh2L0OR0VBzT7UTi0-1OxDAVfZRw5781hh2u6x_xv0R0AGPiwA5t94sBjmZnE02Nsw99p7-78K_yYwzo7WaPcTjxh3fgpZQX6LikyB6uaZmEeCCgAuQPLf0N-xKQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1713944346</pqid></control><display><type>article</type><title>Salvage Stereotactic Body Radiotherapy (SBRT) Following In-Field Failure of Initial SBRT for Spinal Metastases</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Thibault, Isabelle, MD ; Campbell, Mikki, MRT(T) ; Tseng, Chia-Lin, MD ; Atenafu, Eshetu G., MSc ; Letourneau, Daniel, PhD ; Yu, Eugene, MD ; Cho, B.C. John, MD ; Lee, Young K., PhD ; Fehlings, Michael G., MD, PhD ; Sahgal, Arjun, MD</creator><creatorcontrib>Thibault, Isabelle, MD ; Campbell, Mikki, MRT(T) ; Tseng, Chia-Lin, MD ; Atenafu, Eshetu G., MSc ; Letourneau, Daniel, PhD ; Yu, Eugene, MD ; Cho, B.C. John, MD ; Lee, Young K., PhD ; Fehlings, Michael G., MD, PhD ; Sahgal, Arjun, MD</creatorcontrib><description>Purpose We report our experience in salvaging spinal metastases initially irradiated with stereotactic body radiation therapy (SBRT), who subsequently progressed with imaging-confirmed local tumor progression, and were re-irradiated with a salvage second SBRT course to the same level. Methods and Materials From a prospective database, 56 metastatic spinal segments in 40 patients were identified as having been irradiated with a salvage second SBRT course to the same level. In addition, 24 of 56 (42.9%) segments had initially been irradiated with conventional external beam radiation therapy before the first course of SBRT. Local control (LC) was defined as no progression on magnetic resonance imaging at the treated segment, and calculated according to the competing risk model. Overall survival (OS) was evaluated for each patient treated by use of the Kaplan-Meier method. Results The median salvage second SBRT total dose and number of fractions was 30 Gy in 4 fractions (range, 20-35 Gy in 2-5 fractions), and for the first course of SBRT was 24 Gy in 2 fractions (range, 20-35 Gy in 1-5 fractions). The median follow-up time after salvage second SBRT was 6.8 months (range, 0.9-39 months), the median OS was 10.0 months, and the 1-year OS rate was 48%. A longer time interval between the first and second SBRT courses predicted for better OS ( P =.02). The crude LC was 77% (43/56), the 1-year LC rate was 81%, and the median time to local failure was 3.0 months (range, 2.7-16.7 months). Of the 13 local failures, 85% (11/13) and 46% (6/13) showed progression within the epidural space and paraspinal soft tissues, respectively. Absence of baseline paraspinal disease predicted for better LC ( P <.01). No radiation-induced vertebral compression fractures or cases of myelopathy were observed. Conclusion A second course of spine SBRT, most often with 30 Gy in 4 fractions, for spinal metastases that failed initial SBRT is a feasible and efficacious salvage treatment option.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2015.03.029</identifier><identifier>PMID: 26383680</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; BIOMEDICAL RADIOGRAPHY ; COMPRESSION ; Disease Progression ; Dose Fractionation ; EXTERNAL BEAM RADIATION THERAPY ; Female ; Follow-Up Studies ; FRACTURES ; HAZARDS ; Hematology, Oncology and Palliative Medicine ; Humans ; IRRADIATION ; Male ; METASTASES ; Middle Aged ; NEOPLASMS ; NMR IMAGING ; PATIENTS ; RADIATION DOSES ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; Radiosurgery - methods ; Radiosurgery - mortality ; Re-Irradiation - methods ; Salvage Therapy - methods ; Salvage Therapy - mortality ; Spinal Neoplasms - mortality ; Spinal Neoplasms - secondary ; Spinal Neoplasms - surgery ; Time Factors ; Treatment Failure ; VERTEBRAE ; Young Adult</subject><ispartof>International journal of radiation oncology, biology, physics, 2015-10, Vol.93 (2), p.353-360</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c511t-86707789cc794290d80f83b5a89e032dec21ccbec00aeb851576c94e2551df8a3</citedby><cites>FETCH-LOGICAL-c511t-86707789cc794290d80f83b5a89e032dec21ccbec00aeb851576c94e2551df8a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0360301615003508$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26383680$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22458782$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Thibault, Isabelle, MD</creatorcontrib><creatorcontrib>Campbell, Mikki, MRT(T)</creatorcontrib><creatorcontrib>Tseng, Chia-Lin, MD</creatorcontrib><creatorcontrib>Atenafu, Eshetu G., MSc</creatorcontrib><creatorcontrib>Letourneau, Daniel, PhD</creatorcontrib><creatorcontrib>Yu, Eugene, MD</creatorcontrib><creatorcontrib>Cho, B.C. John, MD</creatorcontrib><creatorcontrib>Lee, Young K., PhD</creatorcontrib><creatorcontrib>Fehlings, Michael G., MD, PhD</creatorcontrib><creatorcontrib>Sahgal, Arjun, MD</creatorcontrib><title>Salvage Stereotactic Body Radiotherapy (SBRT) Following In-Field Failure of Initial SBRT for Spinal Metastases</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose We report our experience in salvaging spinal metastases initially irradiated with stereotactic body radiation therapy (SBRT), who subsequently progressed with imaging-confirmed local tumor progression, and were re-irradiated with a salvage second SBRT course to the same level. Methods and Materials From a prospective database, 56 metastatic spinal segments in 40 patients were identified as having been irradiated with a salvage second SBRT course to the same level. In addition, 24 of 56 (42.9%) segments had initially been irradiated with conventional external beam radiation therapy before the first course of SBRT. Local control (LC) was defined as no progression on magnetic resonance imaging at the treated segment, and calculated according to the competing risk model. Overall survival (OS) was evaluated for each patient treated by use of the Kaplan-Meier method. Results The median salvage second SBRT total dose and number of fractions was 30 Gy in 4 fractions (range, 20-35 Gy in 2-5 fractions), and for the first course of SBRT was 24 Gy in 2 fractions (range, 20-35 Gy in 1-5 fractions). The median follow-up time after salvage second SBRT was 6.8 months (range, 0.9-39 months), the median OS was 10.0 months, and the 1-year OS rate was 48%. A longer time interval between the first and second SBRT courses predicted for better OS ( P =.02). The crude LC was 77% (43/56), the 1-year LC rate was 81%, and the median time to local failure was 3.0 months (range, 2.7-16.7 months). Of the 13 local failures, 85% (11/13) and 46% (6/13) showed progression within the epidural space and paraspinal soft tissues, respectively. Absence of baseline paraspinal disease predicted for better LC ( P <.01). No radiation-induced vertebral compression fractures or cases of myelopathy were observed. Conclusion A second course of spine SBRT, most often with 30 Gy in 4 fractions, for spinal metastases that failed initial SBRT is a feasible and efficacious salvage treatment option.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>BIOMEDICAL RADIOGRAPHY</subject><subject>COMPRESSION</subject><subject>Disease Progression</subject><subject>Dose Fractionation</subject><subject>EXTERNAL BEAM RADIATION THERAPY</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>FRACTURES</subject><subject>HAZARDS</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>IRRADIATION</subject><subject>Male</subject><subject>METASTASES</subject><subject>Middle Aged</subject><subject>NEOPLASMS</subject><subject>NMR IMAGING</subject><subject>PATIENTS</subject><subject>RADIATION DOSES</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Radiosurgery - methods</subject><subject>Radiosurgery - mortality</subject><subject>Re-Irradiation - methods</subject><subject>Salvage Therapy - methods</subject><subject>Salvage Therapy - mortality</subject><subject>Spinal Neoplasms - mortality</subject><subject>Spinal Neoplasms - secondary</subject><subject>Spinal Neoplasms - surgery</subject><subject>Time Factors</subject><subject>Treatment Failure</subject><subject>VERTEBRAE</subject><subject>Young Adult</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks9rFDEUgAdR7Fr9D0QCXuph1pdkMpO5CLa4WqgInQreQjbzps2anWyTTGX_ezNM9eBFCISE7_1IvlcUrymsKdD6_W5td8FvD2sGVKyBr4G1T4oVlU1bciF-PC1WwGsoeYZPihcx7gCA0qZ6XpywmkteS1gVY6fdg75F0iUM6JM2yRpy7vsjuda99ekOgz4cyVl3fn3zjmy8c_6XHW_J5VhuLLqebLR1U0Dih3xnk9WOzCwZfCDdwY75_BWTjnlhfFk8G7SL-OpxPy2-bz7dXHwpr759vrz4eFUaQWkqZd1A08jWmKatWAu9hEHyrdCyReCsR8OoMVs0ABq3UlDR1KatkAlB-0Fqflq8XfL6mKyKxiY0d8aPI5qkGKuEbCTL1NlCHYK_nzAmtbfRoHN6RD9FRRvK26riVZ3RakFN8DEGHNQh2L0OR0VBzT7UTi0-1OxDAVfZRw5781hh2u6x_xv0R0AGPiwA5t94sBjmZnE02Nsw99p7-78K_yYwzo7WaPcTjxh3fgpZQX6LikyB6uaZmEeCCgAuQPLf0N-xKQ</recordid><startdate>20151001</startdate><enddate>20151001</enddate><creator>Thibault, Isabelle, MD</creator><creator>Campbell, Mikki, MRT(T)</creator><creator>Tseng, Chia-Lin, MD</creator><creator>Atenafu, Eshetu G., MSc</creator><creator>Letourneau, Daniel, PhD</creator><creator>Yu, Eugene, MD</creator><creator>Cho, B.C. John, MD</creator><creator>Lee, Young K., PhD</creator><creator>Fehlings, Michael G., MD, PhD</creator><creator>Sahgal, Arjun, MD</creator><general>Elsevier Inc</general><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>7X8</scope><scope>OTOTI</scope></search><sort><creationdate>20151001</creationdate><title>Salvage Stereotactic Body Radiotherapy (SBRT) Following In-Field Failure of Initial SBRT for Spinal Metastases</title><author>Thibault, Isabelle, MD ; Campbell, Mikki, MRT(T) ; Tseng, Chia-Lin, MD ; Atenafu, Eshetu G., MSc ; Letourneau, Daniel, PhD ; Yu, Eugene, MD ; Cho, B.C. John, MD ; Lee, Young K., PhD ; Fehlings, Michael G., MD, PhD ; Sahgal, Arjun, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c511t-86707789cc794290d80f83b5a89e032dec21ccbec00aeb851576c94e2551df8a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>BIOMEDICAL RADIOGRAPHY</topic><topic>COMPRESSION</topic><topic>Disease Progression</topic><topic>Dose Fractionation</topic><topic>EXTERNAL BEAM RADIATION THERAPY</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>FRACTURES</topic><topic>HAZARDS</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>IRRADIATION</topic><topic>Male</topic><topic>METASTASES</topic><topic>Middle Aged</topic><topic>NEOPLASMS</topic><topic>NMR IMAGING</topic><topic>PATIENTS</topic><topic>RADIATION DOSES</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Radiosurgery - methods</topic><topic>Radiosurgery - mortality</topic><topic>Re-Irradiation - methods</topic><topic>Salvage Therapy - methods</topic><topic>Salvage Therapy - mortality</topic><topic>Spinal Neoplasms - mortality</topic><topic>Spinal Neoplasms - secondary</topic><topic>Spinal Neoplasms - surgery</topic><topic>Time Factors</topic><topic>Treatment Failure</topic><topic>VERTEBRAE</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thibault, Isabelle, MD</creatorcontrib><creatorcontrib>Campbell, Mikki, MRT(T)</creatorcontrib><creatorcontrib>Tseng, Chia-Lin, MD</creatorcontrib><creatorcontrib>Atenafu, Eshetu G., MSc</creatorcontrib><creatorcontrib>Letourneau, Daniel, PhD</creatorcontrib><creatorcontrib>Yu, Eugene, MD</creatorcontrib><creatorcontrib>Cho, B.C. John, MD</creatorcontrib><creatorcontrib>Lee, Young K., PhD</creatorcontrib><creatorcontrib>Fehlings, Michael G., MD, PhD</creatorcontrib><creatorcontrib>Sahgal, Arjun, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</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>Thibault, Isabelle, MD</au><au>Campbell, Mikki, MRT(T)</au><au>Tseng, Chia-Lin, MD</au><au>Atenafu, Eshetu G., MSc</au><au>Letourneau, Daniel, PhD</au><au>Yu, Eugene, MD</au><au>Cho, B.C. John, MD</au><au>Lee, Young K., PhD</au><au>Fehlings, Michael G., MD, PhD</au><au>Sahgal, Arjun, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Salvage Stereotactic Body Radiotherapy (SBRT) Following In-Field Failure of Initial SBRT for Spinal Metastases</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2015-10-01</date><risdate>2015</risdate><volume>93</volume><issue>2</issue><spage>353</spage><epage>360</epage><pages>353-360</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Purpose We report our experience in salvaging spinal metastases initially irradiated with stereotactic body radiation therapy (SBRT), who subsequently progressed with imaging-confirmed local tumor progression, and were re-irradiated with a salvage second SBRT course to the same level. Methods and Materials From a prospective database, 56 metastatic spinal segments in 40 patients were identified as having been irradiated with a salvage second SBRT course to the same level. In addition, 24 of 56 (42.9%) segments had initially been irradiated with conventional external beam radiation therapy before the first course of SBRT. Local control (LC) was defined as no progression on magnetic resonance imaging at the treated segment, and calculated according to the competing risk model. Overall survival (OS) was evaluated for each patient treated by use of the Kaplan-Meier method. Results The median salvage second SBRT total dose and number of fractions was 30 Gy in 4 fractions (range, 20-35 Gy in 2-5 fractions), and for the first course of SBRT was 24 Gy in 2 fractions (range, 20-35 Gy in 1-5 fractions). The median follow-up time after salvage second SBRT was 6.8 months (range, 0.9-39 months), the median OS was 10.0 months, and the 1-year OS rate was 48%. A longer time interval between the first and second SBRT courses predicted for better OS ( P =.02). The crude LC was 77% (43/56), the 1-year LC rate was 81%, and the median time to local failure was 3.0 months (range, 2.7-16.7 months). Of the 13 local failures, 85% (11/13) and 46% (6/13) showed progression within the epidural space and paraspinal soft tissues, respectively. Absence of baseline paraspinal disease predicted for better LC ( P <.01). No radiation-induced vertebral compression fractures or cases of myelopathy were observed. Conclusion A second course of spine SBRT, most often with 30 Gy in 4 fractions, for spinal metastases that failed initial SBRT is a feasible and efficacious salvage treatment option.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26383680</pmid><doi>10.1016/j.ijrobp.2015.03.029</doi><tpages>8</tpages></addata></record> |
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| ispartof | International journal of radiation oncology, biology, physics, 2015-10, Vol.93 (2), p.353-360 |
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| subjects | Adult Aged Aged, 80 and over BIOMEDICAL RADIOGRAPHY COMPRESSION Disease Progression Dose Fractionation EXTERNAL BEAM RADIATION THERAPY Female Follow-Up Studies FRACTURES HAZARDS Hematology, Oncology and Palliative Medicine Humans IRRADIATION Male METASTASES Middle Aged NEOPLASMS NMR IMAGING PATIENTS RADIATION DOSES Radiology RADIOLOGY AND NUCLEAR MEDICINE Radiosurgery - methods Radiosurgery - mortality Re-Irradiation - methods Salvage Therapy - methods Salvage Therapy - mortality Spinal Neoplasms - mortality Spinal Neoplasms - secondary Spinal Neoplasms - surgery Time Factors Treatment Failure VERTEBRAE Young Adult |
| title | Salvage Stereotactic Body Radiotherapy (SBRT) Following In-Field Failure of Initial SBRT for Spinal Metastases |
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