|
1
|
Adida S, Taori S, Tirmizi Z, Bayley JC, Zinn PO, Flickinger JC, Burton SA, Choi S, Sefcik RK, Gerszten PC. Stereotactic body radiation therapy for spinal metastases from gastrointestinal primary cancers. J Neurooncol 2025; 173:683-694. [PMID: 40227554 DOI: 10.1007/s11060-025-05033-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Accepted: 03/29/2025] [Indexed: 04/15/2025]
Abstract
PURPOSE Metastases from gastrointestinal (GI) primary cancers are considered relatively radioresistant. This study is one of the largest to evaluate outcomes following stereotactic body radiation therapy (SBRT) for GI cancer spinal metastases and supplements its findings with a review of the literature. METHODS A prospectively maintained single-institution database of spinal metastases treated with SBRT was analyzed. Seventy-five patients with 106 GI primary cancer spinal metastases were identified. The median single-fraction dose was 16 Gy (interquartile range (IQR): 14-16). Multi-fraction regimens ranged from 18 to 35 Gy over 2-5 fractions. RESULTS Median follow-up was 5 months (IQR: 1-13). Cumulative incidence rates of 3-, 6-, and 12-month local failure (LF) were 5%, 9%, and 10%, respectively. Rates of 12-month LF were 6% for gastroesophageal, 10% for hepatobiliary, and 13% for colorectal cancers. Multilevel tumors ≥ 2 vertebrae were associated with LF (p = 0.006, HR: 5.61, 95% CI: 1.61-19.5). Rates of 3-, 6-, and 12-month overall survival (OS) were 68%, 50%, and 41%, respectively. Multivariable analysis showed epidural disease associated with inferior OS (p = 0.037, HR: 1.75, 95% CI: 1.04-2.96). Complete or partial pain responses for 93 tumors (88%) presenting with pain were 60%, 51%, 32%, and 32% after 1, 3, 6, and 12 months, respectively. Ten vertebral compression fractures (9%) developed following treatment. Twelve radiation toxicities (11%) were observed, with no cases of neuropathy or myelopathy. CONCLUSIONS SBRT offers effective local tumor control and pain palliation with minimal toxicity for GI cancer spinal metastases, whose incidence is expected to rise with advances in screening and systemic therapies.
Collapse
Affiliation(s)
- Samuel Adida
- School of Medicine, University of Pittsburgh Medical Center, 3550 Terrace St, Pittsburgh, PA, 15213, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St Suite B-400, Pittsburgh, PA, 15213, USA
| | - Suchet Taori
- School of Medicine, University of Pittsburgh Medical Center, 3550 Terrace St, Pittsburgh, PA, 15213, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St Suite B-400, Pittsburgh, PA, 15213, USA
| | - Zayaan Tirmizi
- School of Medicine, University of Pittsburgh Medical Center, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - James C Bayley
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St Suite B-400, Pittsburgh, PA, 15213, USA
| | - Pascal O Zinn
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St Suite B-400, Pittsburgh, PA, 15213, USA
| | - John C Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Steven A Burton
- Department of Radiation Oncology, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Serah Choi
- Department of Radiation Oncology, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Roberta K Sefcik
- Department of Neurosurgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St Suite B-400, Pittsburgh, PA, 15213, USA.
- Department of Radiation Oncology, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA.
| |
Collapse
|
|
2
|
Lam FC, Guru S, AbuReesh D, Hori YS, Chuang C, Liu L, Wang L, Gu X, Szalkowski GA, Wang Z, Wohlers C, Tayag A, Emrich SC, Ustrzynski L, Zygourakis CC, Desai A, Hayden Gephart M, Byun J, Pollom EL, Rahimy E, Soltys S, Park DJ, Chang SD. Use of Carbon Fiber Implants to Improve the Safety and Efficacy of Radiation Therapy for Spine Tumor Patients. Brain Sci 2025; 15:199. [PMID: 40002531 PMCID: PMC11852773 DOI: 10.3390/brainsci15020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 01/22/2025] [Accepted: 02/13/2025] [Indexed: 02/27/2025] Open
Abstract
Current standard of care treatment for patients with spine tumors includes multidisciplinary approaches, including the following: (1) surgical tumor debulking, epidural spinal cord decompression, and spine stabilization techniques; (2) systemic chemo/targeted therapies; (3) radiation therapy; and (4) surveillance imaging for local disease control and recurrence. Titanium pedicle screw and rod fixation have become commonplace in the spine surgeon's armamentarium for the stabilization of the spine following tumor resection and separation surgery. However, the high degree of imaging artifacts seen with titanium implants on postoperative CT and MRI scans can significantly hinder the accurate delineation of vertebral anatomy and adjacent neurovascular structures to allow for the safe and effective planning of downstream radiation therapies and detection of disease recurrence. Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) spine implants have emerged as a promising alternative to titanium due to the lack of artifact signals on CT and MRI, allowing for more accurate and safe postoperative radiation planning. In this article, we review the tenants of the surgical and radiation management of spine tumors and discuss the safety, efficacy, and current limitations of CFR-PEEK spine implants in the multidisciplinary management of spine oncology patients.
Collapse
Affiliation(s)
- Fred C. Lam
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Santosh Guru
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Deyaldeen AbuReesh
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Yusuke S. Hori
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Cynthia Chuang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Lianli Liu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Lei Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Xuejun Gu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Gregory A. Szalkowski
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Ziyi Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Christopher Wohlers
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Armine Tayag
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Sara C. Emrich
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Louisa Ustrzynski
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Corinna C. Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Atman Desai
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Melanie Hayden Gephart
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - John Byun
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Erqi Liu Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Elham Rahimy
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Scott Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - David J. Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Steven D. Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| |
Collapse
|
|
3
|
Pacella G, Altomare C, Pileri M, Andresciani F, Bernetti C, Ferrari U, Bruno A, Bitonti MT, Zobel BB, Faiella E, Grasso RF. Percutaneous Cryoablation of Recurrent or Oligometastatic Tumors in Thoracoabdominal Soft Tissues: Safety, Effectiveness, and Technical Aspects. J Vasc Interv Radiol 2024; 35:226-231. [PMID: 37797742 DOI: 10.1016/j.jvir.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/06/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE To assess the effectiveness and safety of cryoablation (CRA) for the treatment of recurrent or oligometastatic solid tumors located in the thoracoabdominal soft tissues. MATERIALS AND METHODS Twenty-two percutaneous CRA procedures performed in 19 patients to treat recurrent or oligometastatic tumors in thoracoabdominal soft tissue were retrospectively examined. All procedures were performed between January 2015 and June 2021 under ultrasound and computed tomography (CT) guidance, and the most complex procedures were performed with CT-based navigation systems. The histology of the primary tumors included colorectal adenocarcinoma, squamous cell lung carcinoma, pancreatic adenocarcinoma, renal cell carcinoma, and hepatocellular carcinoma. Adverse events, technical success, and local tumor control were analyzed. RESULTS The mean age of the patients was 66.5 years, with a mean tumor size of 24.8 mm. The mean time of the procedures was 68 minutes, with a mean number of 2.5 cryoprobes used. Hydrodissection was performed in 63% of the procedures to protect the surrounding anatomical structures. The mean size of the ice ball, measured on axial CT scans at the end of the procedures, was 43.5 mm. No severe adverse events were observed. Technical success was achieved in all cases. Three patients experienced local tumor progression (2 residual disease and 1 recurrence), which were successfully treated with a second CRA procedure. CONCLUSIONS Percutaneous CRA is a safe and effective therapy in selected cases of recurrent or oligometastatic tumors in the thoracoabdominal soft tissues.
Collapse
Affiliation(s)
- Giuseppina Pacella
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy; Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy.
| | - Carlo Altomare
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy; Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Matteo Pileri
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy; Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Flavio Andresciani
- Department of Diagnostic and Interventional Radiology, Santa Maria Goretti Hospital, Via Lucia Scaravelli, Latina, Italy
| | - Caterina Bernetti
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy; Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Ugo Ferrari
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy; Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Amalia Bruno
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy; Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Maria Teresa Bitonti
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy; Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Bruno Beomonte Zobel
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy; Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Eliodoro Faiella
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy; Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Rosario Francesco Grasso
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy; Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| |
Collapse
|
|
4
|
Newman WC, Larsen AG, Bilsky MH. The NOMS approach to metastatic tumors: Integrating new technologies to improve outcomes. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:487-499. [PMID: 37116749 DOI: 10.1016/j.recot.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/23/2023] [Indexed: 04/30/2023] Open
Abstract
Treatment paradigms for patients with spine metastases have evolved significantly over the past two decades. The most transformative change to these paradigms has been the integration of spinal stereotactic radiosurgery (sSRS). sSRS allows for the delivery of tumoricidal radiation doses with sparing of nearby organs at risk, particularly the spinal cord. Evidence supports the safety and efficacy of radiosurgery as it currently offers durable local tumor control with low complication rates even for tumors previously considered radioresistant to conventional external beam radiation therapy. The role for surgical intervention remains consistent, but a trend has been observed toward less aggressive, often minimally invasive techniques. Using modern technologies and improved instrumentation, surgical outcomes continue to improve with reduced morbidity. Additionally, targeted agents such as biologics and checkpoint inhibitors have revolutionized cancer care by improving both local control and patient survival. These advances have brought forth a need for new prognostication tools and a more critical review of long-term outcomes. The complex nature of current treatment schemes necessitates a multidisciplinary approach including surgeons, medical oncologists, radiation oncologists, interventionalists and pain specialists. This review recapitulates the current state-of-the-art, evidence-based data on the treatment of spinal metastases and integrates these data into a decision framework, NOMS, which is based on four sentinel pillars of decision making in metastatic spine tumors: Neurological status, Oncologic tumor behavior, Mechanical stability, and Systemic disease burden and medical co-morbidities.
Collapse
Affiliation(s)
- W C Newman
- Memorial Sloan Kettering Cancer Center, India
| | - A G Larsen
- Memorial Sloan Kettering Cancer Center, India; Weill Medical College of Cornell University, India
| | - M H Bilsky
- Memorial Sloan Kettering Cancer Center, India; Weill Medical College of Cornell University, India.
| |
Collapse
|
|
5
|
Newman WC, Larsen AG, Bilsky MH. The NOMS approach to metastatic tumors: Integrating new technologies to improve outcomes. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:S487-S499. [PMID: 37562765 DOI: 10.1016/j.recot.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/23/2023] [Indexed: 08/12/2023] Open
Abstract
Treatment paradigms for patients with spine metastases have evolved significantly over the past two decades. The most transformative change to these paradigms has been the integration of spinal stereotactic radiosurgery (sSRS). sSRS allows for the delivery of tumoricidal radiation doses with sparing of nearby organs at risk, particularly the spinal cord. Evidence supports the safety and efficacy of radiosurgery as it currently offers durable local tumor control with low complication rates even for tumors previously considered radioresistant to conventional external beam radiation therapy. The role for surgical intervention remains consistent, but a trend has been observed toward less aggressive, often minimally invasive techniques. Using modern technologies and improved instrumentation, surgical outcomes continue to improve with reduced morbidity. Additionally, targeted agents such as biologics and checkpoint inhibitors have revolutionized cancer care by improving both local control and patient survival. These advances have brought forth a need for new prognostication tools and a more critical review of long-term outcomes. The complex nature of current treatment schemes necessitates a multidisciplinary approach including surgeons, medical oncologists, radiation oncologists, interventionalists and pain specialists. This review recapitulates the current state-of-the-art, evidence-based data on the treatment of spinal metastases and integrates these data into a decision framework, NOMS, which is based on four sentinel pillars of decision making in metastatic spine tumors: neurological status, Oocologic tumor behavior, mechanical stability and systemic disease burden and medical co-morbidities.
Collapse
Affiliation(s)
- W C Newman
- Memorial Sloan Kettering Cancer Center, Chennai, Tamil Nadu, India
| | - A G Larsen
- Memorial Sloan Kettering Cancer Center, Chennai, Tamil Nadu, India; Weill Medical College of Cornell University, India
| | - M H Bilsky
- Memorial Sloan Kettering Cancer Center, Chennai, Tamil Nadu, India; Weill Medical College of Cornell University, India.
| |
Collapse
|
|
6
|
Kim E, Kim MS, Paik EK, Chang UK, Kong CB. Treatment outcomes of stereotactic body radiation therapy for primary and metastatic sarcoma of the spine. Radiat Oncol 2023; 18:156. [PMID: 37736735 PMCID: PMC10514933 DOI: 10.1186/s13014-023-02346-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE This study evaluated the treatment outcomes of spine stereotactic body radiation therapy (SBRT) in sarcoma patients. MATERIALS AND METHODS A total of 44 sarcoma patients and 75 spinal lesions (6 primary tumors, 69 metastatic tumors) treated with SBRT were retrospectively reviewed between 2006 and 2017. The median radiation dose was 33 Gy (range, 18-45 Gy) in 3 fractions (range, 1-5) prescribed to the 75% isodose line. RESULTS The median follow-up duration was 18.2 months. The 1-year local control was 76.4%, and patients treated with single vertebral body were identified as a favorable prognostic factor on multivariate analyses. Progression-free survival at 1 year was 31.9%, with the interval between initial diagnosis and SBRT and extent of disease at the time of treatment being significant prognostic factors. The 1-year overall survival was 80.5%, and PTV and visceral metastases were independently associated with inferior overall survival. CONCLUSION SBRT for spinal sarcoma is effective in achieving local control, particularly when treating a single vertebral level with a limited extent of disease involvement, resulting in an excellent control rate. The extent of disease at the time of SBRT is significantly correlated with survival outcomes and should be considered when treating spine sarcoma.
Collapse
Affiliation(s)
- Eunji Kim
- Department of Radiation Oncology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Eun Kyung Paik
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Ung-Kyu Chang
- Department of Neurosurgery, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Chang-Bae Kong
- Department of Orthopedic Surgery, Korea Institute of Radiological and Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul, 01812, Republic of Korea.
| |
Collapse
|
|
7
|
Hao L, Chen X, Chen Q, Xu Y, Zhang B, Yang Z, Zhong J, Zhou Q. Application and Development of Minimally Invasive Techniques in the Treatment of Spinal Metastases. Technol Cancer Res Treat 2022; 21:15330338221142160. [PMID: 36476013 PMCID: PMC9742696 DOI: 10.1177/15330338221142160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
With the improvement of medical technology, the quality of life and prognosis of patients with malignant tumors have been greatly improved, and surgical treatment strategies for patients with spinal metastatic tumors have received extensive attention. Traditional open surgery for spinal metastases has problems such as large trauma, slow recovery, and influence on subsequent systemic treatment. Minimally invasive spine surgery has similar clinical outcomes to traditional open surgery, but minimally invasive spine surgery is less invasive and has a shorter recovery time. Minimally invasive spine surgery was initially applied to non-neoplastic diseases such as spinal degeneration and trauma, and was gradually applied to the treatment of spinal metastatic tumors and spinal deformities. For patients with spinal metastases, a shorter recovery time is helpful for early postoperative radiotherapy, thereby achieving a more satisfactory tumor control effect. This review discusses the application of minimally invasive spine surgery in the treatment of spinal metastatic tumors from the concept, surgical purpose, indications, and surgical selection, so as to provide reference for clinical practice.
Collapse
Affiliation(s)
- Lu Hao
- Science and Education Department, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, China
| | - Xi Chen
- Central Laboratory, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Qiuyan Chen
- Science and Education Department, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, China
| | - Yuzhong Xu
- Department of Clinical Laboratory, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Baozhu Zhang
- Department of Radiotherapy, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zhe Yang
- The First Clinical Medical School, Southern Medical University, Guangzhou, China
| | - Junxin Zhong
- The Second Clinical Medical School, Southern Medical University, Guangzhou, China
| | - Qing Zhou
- Central Laboratory, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, China,Qing Zhou, Central Laboratory, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, China.
| |
Collapse
|
|
8
|
Diabira S, Akhaddar A, Lebhar J, Breitel D, Bacon P, Blamoutier A. Metastasi spinali degli adulti. Neurologia 2022. [DOI: 10.1016/s1634-7072(22)46431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
|
9
|
Boyce-Fappiano D, Damron EP, Farooqi A, Mitra D, Conley AP, Somaiah N, Araujo DM, Livingston JA, Ratan R, Keung EZ, Roland CL, Guadagnolo BA, Bishop AJ. Hypofractionated radiation therapy for unresectable or metastatic sarcoma lesions. Adv Radiat Oncol 2022; 7:100913. [PMID: 35647398 PMCID: PMC9133361 DOI: 10.1016/j.adro.2022.100913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/14/2022] [Indexed: 12/25/2022] Open
Abstract
Purpose Given the relative radioresistance of sarcomas and their often large size, conventional palliative radiation therapy (RT) often offers limited tumor control and symptom relief. We report on our use of hypofractionated RT (HFRT) as a strategy to promote durable local disease control and optimize palliation. Methods and Materials We retrospectively reviewed 73 consecutive patients with sarcoma who received >10 fractions of HFRT from 2017 to 2020. Clinical scenarios included: (1) palliative or symptomatic intent (34%), (2) an unresectable primary (27%), (3) oligometastatic disease (16%), and (4) oligoprogressive disease (23%). Results The HFRT target was a primary tumor in 64% of patients with a median dose of 45 Gy in 15 fractions (59% ≥45 Gy). The 1-year disease-specific survival was 59%, which was more favorable for patients receiving HFRT for oligometastatic (1-year 100%) or oligoprogressive (1-year 73%) disease (P = .001). The 1-year local control (LC) of targeted lesions was 73%. A metastatic target (1-year 95% vs 60% primary; P = .02; hazard ratio, 0.27; P = .04) and soft tissue origin (1-year 78% vs 61% bone; P = .01; hazard ratio, 0.33; P = .02) were associated with better LC. The rate of distant failure was high with a 6-month distant metastasis-free survival of only 43%. For patients not planned for adjuvant systemic therapy (n = 53), the median systemic therapy break was 9 months and notably longer in oligometastatic (13 months), oligoprogressive (12 months) or unresectable (13 months) disease. HFRT provided palliative relief in 95% of cases with symptoms. Overall, 49% of patients developed acute grade 1 to 2 RT toxicities (no grade 3-5). No late grade 2 to 5 toxicities were observed. Conclusions HFRT is an effective treatment strategy for patients with unresectable or metastatic sarcoma to provide durable LC, symptom relief, and systemic therapy breaks with limited toxic effects.
Collapse
|
|
10
|
Stereotactic Body Radiotherapy in Oligomestatic/Oligoprogressive Sarcoma: Safety and Effectiveness Beyond Intrinsic Radiosensitivity. Cancer J 2021; 27:423-427. [PMID: 34904803 DOI: 10.1097/ppo.0000000000000551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Metastatic soft tissue sarcoma (STS) patients may benefit from local ablative treatments due to modest efficacy of systemic chemotherapy. However, use of stereotactic body radiotherapy (SBRT) is controversial because of presumed radioresistance of STS. METHODS Patients treated with SBRT for oligometastatic and oligoprogressive metastatic STS were retrospectively reviewed to assess results in terms of local control (LC), disease-free survival (DFS), and overall survival (OS). Incidence and grade of adverse events were reported. Statistical analysis was performed to identify variables correlated with outcome and toxicity. RESULTS Forty patients were treated with SBRT to a median biologic effective dose (BED) of 105 (66-305) Gy5 to 77 metastases. Two-year LC, DFS, and OS were 67%, 23%, and 40%. Improved LC was shown in patients receiving a BED >150 Gy5 (hazard ratio [HR], 3.9; 95% confidence interval [CI], 1.6-9.7; P = 0.028). A delay >24 months between primary tumor diagnosis and onset of metastases was associated with improved DFS (HR, 0.46; 95% CI, 0.22-0.96; P = 0.01) and OS (HR, 0.48; 95% CI, 0.23-0.99; P = 0.03). No toxicity grade ≥3 was observed. CONCLUSIONS Stereotactic body radiotherapy is effective in metastatic STS with a benign toxicity profile. A BED >150 Gy5 is required to maximize tumor control rates. Metastatic relapse >24 months after diagnosis is correlated to improved survival.
Collapse
|
|
11
|
Chander S, Ngan C, Choong PFM. Management of Metastatic Sarcoma. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
|
12
|
Shah M, Gadia A, Nene A, Patel P. Management of Metastatic Spine and Hip Alveolar Soft Part Sarcoma: Case Report and Review of Literature. Asian J Neurosurg 2020; 15:1011-1015. [PMID: 33708679 PMCID: PMC7869264 DOI: 10.4103/ajns.ajns_290_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/09/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor. Primary or metastatic involvement of the spine is unusual in ASPS. In most case, it is refractory to chemotherapy and radiation. Surgical resection is the most effective intervention. We report the case of a 38-year-old female having ASPS along with metastatic spine and hip involvement treated surgically as a single-stage operation, which is the first of its kind approach to our knowledge. We present the case of a 38-year-old female with simultaneous L4 pathological fracture with symptomatic lumbar canal stenosis without focal neurology and pathological fracture of neck of femur of left hip, secondary to metastatic ASPS. Since both conditions were contributing equally to her disability and demanded early intervention, they were treated simultaneously with intralesional excision of the tumor and posterior stabilization of the spine and left hip proximal femur resection and replaced it with proximal femur endoprosthesis as a single-stage operation. Postoperatively, she had significant relief of radiculopathy and left hip pain. She was mobilized out of bed on the postoperative day 1 and was discharged from hospital on the postoperative day 6. She was given chemotherapy drug sunitib postoperative. At her last follow-up, 20 months' postoperative, she was asymptomatic and was independent in terms of activities of daily living. Metastatic ASPS of the spine and hip is a rare clinical entity. Simultaneous surgical treatment of the spine and hip pathology is technically demanding. If the conditions demands, as in our case, both of them can be managed safely in a single-stage with good midterm outcome.
Collapse
Affiliation(s)
- Munjal Shah
- Department of Spine Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Akshay Gadia
- Department of Spine Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Abhay Nene
- Department of Spine Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Priyank Patel
- Department of Spine Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| |
Collapse
|
|
13
|
Tinkle CL, Singh C, Lloyd S, Guo Y, Li Y, Pappo AS, DuBois SG, Lucas JT, Haas-Kogan DA, Terezakis SA, Braunstein SE, Krasin MJ. Stereotactic Body Radiation Therapy for Metastatic and Recurrent Solid Tumors in Children and Young Adults. Int J Radiat Oncol Biol Phys 2020; 109:1396-1405. [PMID: 33259934 DOI: 10.1016/j.ijrobp.2020.11.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The use of stereotactic body radiation therapy (SBRT) in pediatric patients has been underreported. We reviewed practice patterns, outcomes, and toxicity of SBRT in this population. METHODS AND MATERIALS In this multi-institutional study, 55 patients with 107 non-central nervous system lesions treated with SBRT between 2010 and 2016 were reviewed. Treatment response was evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 and modified RECIST v1.1 criteria for soft-tissue and bone lesions, respectively. Patterns of local failure (LF) were assessed dosimetrically. The cumulative incidence of LF and toxicity were estimated accounting for the competing risk event of death. Predictors of LF were identified through joint frailty models for clustered competing risks. RESULTS The median (range) dose/fraction was 7 (4.5-25) Gy, the total (range) dose/site was 35 (12-45), and the median (range) number of fractions was 5 (1-9). The radiographic response rates of bone and soft-tissue lesions were 90.6% and 76.7%, respectively. Symptom improvement was observed for 62% of symptomatic sites. A total of 27 LFs were documented, with 14 in-field, 9 marginal, and 4 out-of-field LFs. The 1-year estimated cumulative LF rate, progression-free survival, and overall survival were 25.2% (95% confidence interval [CI], 17.2%-36.1%), 17.5% (95% CI, 9.0%-34.1%), and 61% (95% CI, 48.9%-76.1%), respectively. Lesion type (soft tissue vs bone) was the only significant predictor of LF on multivariable analysis (P = .04), with increased hazard for soft-tissue lesions. No acute or late toxicity of grade 4 or higher was observed; the estimated 1-year cumulative incidence of late toxicity of any grade was 7.5% (95% CI, 3.6%-12.1%). CONCLUSIONS The SBRT was well tolerated and resulted in radiographic response and symptom palliation in most pediatric patients with advanced disease. The 1-year cumulative LF rate of 25% will serve as a benchmark for further modifications to radiation therapy indications, parameters, and combination therapy.
Collapse
Affiliation(s)
- Christopher L Tinkle
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - Charu Singh
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Shane Lloyd
- Department of Radiation Oncology, University of California, San Francisco
| | - Yian Guo
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yimei Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Alberto S Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Steven G DuBois
- Department of Pediatrics, University of California, San Francisco
| | - John T Lucas
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Stephanie A Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California, San Francisco
| | - Matthew J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| |
Collapse
|
|
14
|
Parsai S, Juloori A, Angelov L, Scott JG, Krishnaney AA, Udo-Inyang I, Zhuang T, Qi P, Kolar M, Anderson P, Zahler S, Chao ST, Suh JH, Murphy ES. Spine radiosurgery in adolescents and young adults: early outcomes and toxicity in patients with metastatic Ewing sarcoma and osteosarcoma. J Neurosurg Spine 2020; 32:491-498. [PMID: 31783349 DOI: 10.3171/2019.9.spine19377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 09/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There are limited data on spine stereotactic radiosurgery (SRS) in treating adolescent and young adult (AYA) patients. SRS has the advantages of highly conformal radiation dose delivery in the upfront and retreatment settings, means for dose intensification, and administration over a limited number of sessions leading to a decreased treatment burden. In this study, the authors report the oncological and toxicity outcomes for AYA patients with metastatic sarcoma treated with spine radiosurgery and provide clinicians a guide for considerations in dose, volume, and fractionation. METHODS An institutional review board-approved database of patients treated with SRS in the period from October 2014 through December 2018 was queried. AYA patients, defined by ages 15-29 years, who had been treated with SRS for spine metastases from Ewing sarcoma or osteosarcoma were included in this analysis. Patients with follow-ups shorter than 6 months after SRS were excluded. Local control, overall survival, and toxicity were reported. RESULTS Seven patients with a total of 11 treated lesions were included in this study. Median patient age was 20.3 years (range 15.1-26.1 years). Three patients had Ewing sarcoma (6 lesions) and 4 patients had osteosarcoma (5 lesions). The median dose delivered was 35 Gy in 5 fractions (range 16-40 Gy, 1-5 fractions). The median follow-up was 11.1 months (range 6.8-26.0 months). Three local failures were observed within the follow-up period. No acute grade 3 or greater toxicity was observed. One patient developed late grade 3 toxicity consisting of radiation enteritis. This patient had previously received radiation to an overlapping volume with conventional fractionation. SRS re-irradiation for this patient was also performed concurrently with chemotherapy administration. No late grade 4 or higher toxicities were observed. No pain flare or vertebral compression fracture was observed. Three patients died within the follow-up period. CONCLUSIONS SRS for spine metastases from Ewing sarcoma and osteosarcoma can be considered as a treatment option in AYA patients and is associated with acceptable toxicity rates. Further studies must be conducted to determine long-term local control and toxicity for this treatment modality.
Collapse
Affiliation(s)
- Shireen Parsai
- 1Department of Radiation Oncology, Taussig Cancer Institute
| | - Aditya Juloori
- 1Department of Radiation Oncology, Taussig Cancer Institute
| | - Lilyana Angelov
- 2Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center
- 3Department of Neurosurgery, Neurological Institute
- 5Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| | - Jacob G Scott
- 1Department of Radiation Oncology, Taussig Cancer Institute
| | | | | | | | - Peng Qi
- 1Department of Radiation Oncology, Taussig Cancer Institute
| | - Matthew Kolar
- 1Department of Radiation Oncology, Taussig Cancer Institute
| | - Peter Anderson
- 4Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation; and
- 5Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| | - Stacey Zahler
- 4Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation; and
| | - Samuel T Chao
- 1Department of Radiation Oncology, Taussig Cancer Institute
- 2Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center
- 5Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| | - John H Suh
- 1Department of Radiation Oncology, Taussig Cancer Institute
- 2Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center
- 5Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| | - Erin S Murphy
- 1Department of Radiation Oncology, Taussig Cancer Institute
- 2Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center
- 5Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
|
15
|
Honda A, Iizuka Y, Okamoto M, Shiba S, Koshi H, Mieda T, Ishiwata S, Kakuta Y, Tajika T, Ohno T, Chikuda H. Malignant Peripheral Nerve Sheath Tumor of the Cervical Spine Treated with Surgical Resection Followed by X-ray Radiotherapy or Carbon Ion Radiotherapy: A Report of Three Cases. Spine Surg Relat Res 2020; 4:269-273. [PMID: 32864495 PMCID: PMC7447340 DOI: 10.22603/ssrr.2019-0100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/22/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction Spinal malignant peripheral nerve sheath tumors (MPNSTs) are extremely rare. Because of vital surroundings, en bloc resection can be difficult in MPNSTs of the cervical spine. Herein, we report three cases of MPNST followed by radiotherapy or carbon ion radiotherapy (CIRT) after surgery. Technical Note In case 1, the patient underwent subtotal resection from both a posterior and anterior approach following by adjuvant X-ray radiotherapy. The patient died 13 years after surgery due to liver cancer unrelated to MPNST. In case 2, recurrence spread to the spinal canal in 10 months after primary CIRT. The patient underwent resection of the spinal canal lesion with the residual lesion treated by additional CIRT. Recurrence could be controlled for at least 1 year. In case 3, the patient underwent partial resection for the spinal canal lesion with the residual lesion treated by CIRT. Intradural and extradural recurrences from outside of the CIRT field were observed at 3 years after surgery. Conclusions Complete resection and adjuvant X-ray radiotherapy would be an effective treatment for MPNST of the cervical spine, even if en bloc resection with a wide margin is impossible. CIRT for the residual tumor after incomplete resection may have the potential to be an additional treatment option; however, further investigation is warranted.
Collapse
Affiliation(s)
- Akira Honda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahiko Okamoto
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shintaro Shiba
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Hiromi Koshi
- Clinical Department of Pathology, Gunma University Hospital, Maebashi, Japan
| | - Tokue Mieda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sho Ishiwata
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yohei Kakuta
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| |
Collapse
|
|
16
|
Beeler WH, Speth KA, Broderick MT, Jairath NK, Ballouz D, Gharzai LA, Jackson WC, Kim MM, Owen D, Szerlip NJ, Paradis KC, Spratt DE. Local Control and Toxicity of Multilevel Spine Stereotactic Body Radiotherapy. Neurosurgery 2020; 86:E164-E172. [PMID: 31541240 DOI: 10.1093/neuros/nyz348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/16/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Spine stereotactic body radiotherapy (sSBRT) is commonly limited to 1 or 2 vertebral levels given a paucity of efficacy and toxicity data when more than 2 levels are treated. OBJECTIVE To prove our hypothesis that multilevel sSBRT could provide similar rates of local control (LC) (primary endpoint) and toxicity as single-level treatment using the same clinical target, planning target, and planning organ-at-risk volumes. METHODS We analyzed consecutive cases of sSBRT treated from 2013 to 2017. Time-to-event outcomes for single-level and multilevel cases were compared using mixed effect Cox models and differences in toxicity rates were evaluated using linear mixed effect models. All models incorporate a patient-level random intercept to account for any within-patient correlation across cases. RESULTS There were 101 single-level and 84 multilevel sSBRT cases (2-7 continuous vertebral levels). One-year LC was 95% vs 85%, respectively. After adjusting for baseline covariates, dose delivered, and accounting for within-patient correlation, there was no significant difference in time to local failure (hazard ratio, HR 1.79 [0.59-5.4]; P = .30). Pain improved in 83.5% of the 139 initially symptomatic tumors. There were no significant differences in grade 2+ acute or late toxicities between single-level and multilevel sSBRT. CONCLUSION With rigorous patient immobilization, quality assurance, and image guidance, multilevel sSBRT provides high rates of LC, similar to single-level treatment, without need for larger planning volume margins. Efforts to improve prognostication and case selection for multilevel sSBRT are warranted to ensure that the benefits of improved LC over palliative radiation are justified.
Collapse
Affiliation(s)
- Whitney H Beeler
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kelly A Speth
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | | | - Neil K Jairath
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Dena Ballouz
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Laila A Gharzai
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - William C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Michelle M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Dawn Owen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Kelly C Paradis
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
|
17
|
Yuce Sari S, Cengiz M, Dauletkazin A, Yazici G, Gultekin M, Hurmuz P, Yildiz F, Zorlu F, Gurkaynak M, Akyol F, Ozyigit G. Hypofractionated radiotherapy for non-metastatic bone and soft tissue sarcomas. Cancer Radiother 2019; 23:853-859. [PMID: 31640927 DOI: 10.1016/j.canrad.2019.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/01/2019] [Accepted: 06/10/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate the efficacy and toxicity of hypofractionated radiotherapy in non-metastatic soft tissue and bone sarcomas. PATIENTS AND METHODS Thirty patients underwent hypofractionated radiotherapy between 2007 and 2015. Overall, 17 patients underwent primary hypofractionated radiotherapy, nine underwent hypofractionated radiotherapy for reirradiation, and four received a boost dose via hypofractionated radiotherapy after external beam radiotherapy. Most common disease sites were head and neck and retroperitoneum. Hypofractionated radiotherapy was administered with a definitive, adjuvant, or neoadjuvant intent. RESULTS Median age was 37 years (range: 11-82 years). Median hypofractionated radiotherapy dose was 35Gy (range: 20-50Gy) in three to five fractions. Median follow-up was 21 months (range: 1-108 months). One- and 2-year overall survival rate was 75% and 52%, respectively. One- and 2-year local recurrence-free survival rate was 59% and 48%, with local recurrence rates of 16% and 33% in 1 and 2 years, respectively. Univariate analysis revealed tumour size (P=0.04), hypofractionated radiotherapy intent (P=0.016) and reirradiation (P=0.001) as prognostic factors for local recurrence-free survival. Severe late toxicity was observed in one patient as grade 3 trismus. CONCLUSION Hypofractionated radiotherapy as the primary treatment or for reirradiation has been shown to be safe in the treatment of bone and soft tissue sarcomas. It can provide relatively good local control and survival rates.
Collapse
Affiliation(s)
- S Yuce Sari
- Department of Radiation Oncology, Hacettepe University Medical School, 06100 Ankara, Turkey.
| | - M Cengiz
- Department of Radiation Oncology, Hacettepe University Medical School, 06100 Ankara, Turkey
| | - A Dauletkazin
- Department of Radiation Oncology, Mehmet Akif İnan Training and Research Hospital, Sanliurfa, Turkey
| | - G Yazici
- Department of Radiation Oncology, Hacettepe University Medical School, 06100 Ankara, Turkey
| | - M Gultekin
- Department of Radiation Oncology, Hacettepe University Medical School, 06100 Ankara, Turkey
| | - P Hurmuz
- Department of Radiation Oncology, Hacettepe University Medical School, 06100 Ankara, Turkey
| | - F Yildiz
- Department of Radiation Oncology, Hacettepe University Medical School, 06100 Ankara, Turkey
| | - F Zorlu
- Department of Radiation Oncology, Hacettepe University Medical School, 06100 Ankara, Turkey
| | - M Gurkaynak
- Department of Radiation Oncology, Hacettepe University Medical School, 06100 Ankara, Turkey
| | - F Akyol
- Department of Radiation Oncology, Hacettepe University Medical School, 06100 Ankara, Turkey
| | - G Ozyigit
- Department of Radiation Oncology, Hacettepe University Medical School, 06100 Ankara, Turkey
| |
Collapse
|
|
18
|
Fridley J, Gokaslan ZL. The evolution of surgical management for vertebral column tumors. J Neurosurg Spine 2019; 30:417-423. [PMID: 30933909 DOI: 10.3171/2018.12.spine18708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 12/14/2018] [Indexed: 11/06/2022]
Abstract
In BriefThere has been a significant shift in treatment paradigms for both primary and metastatic spine tumors over the last several decades. This article highlights some of the more important treatment advances that practitioners should be made aware of. It is important to not only incorporate these changes into individual practice but also appreciate the treatment trends that herald a significantly different future for spine tumor treatment.
Collapse
|
|
19
|
McGee HM, Carpenter TJ, Ozbek U, Kirkwood KA, Tseng TC, Blacksburg S, Germano IM, Green S, Buckstein M. Analysis of Local Control and Pain Control After Spine Stereotactic Radiosurgery Reveals Inferior Outcomes for Hepatocellular Carcinoma Compared With Other Radioresistant Histologies. Pract Radiat Oncol 2019; 9:89-97. [DOI: 10.1016/j.prro.2018.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/18/2018] [Accepted: 11/29/2018] [Indexed: 01/10/2023]
|
|
20
|
Loi M, Duijm M, Baker S, Rossi L, Grunhagen D, Verhoef C, Nuyttens J. Stereotactic body radiotherapy for oligometastatic soft tissue sarcoma. Radiol Med 2018; 123:871-878. [DOI: 10.1007/s11547-018-0912-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
|
|
21
|
Paik EK, Kim MS, Cho CK, Yoo HJ, Jang WI, Seo YS, Jin SH, Jeon DG, Lee DH. Feasibility of using stereotactic body radiation therapy for unresectable soft tissue tumors of the trunk. Oncotarget 2018; 9:27851-27857. [PMID: 29963242 PMCID: PMC6021255 DOI: 10.18632/oncotarget.25539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/17/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose To evaluate the feasibility of stereotactic body radiation therapy (SBRT) for unresectable soft tissue tumors of the trunk. Materials and Methods Between January 2002 and December 2008, 23 patients with 36 lesions of soft tissue tumors, which were located in the trunk and not suitable for resection, underwent SBRT. Among the 36 lesions, 31 were malignant and 5 were benign. The median tumor volume was 24 cm3 (range, 2.6–213 cm3). SBRT doses ranged from 20 to 48 Gy in 1–5 fractions. Results With a median follow-up of 73 months, the overall survival (OS) and local control (LC) rates at 5 years were 39% and 52%, respectively. For malignant tumors, the OS and LC rates at 5 years were 28% and 47%, respectively. For benign tumors, the OS and LC rates at 5 years were 80% and 100%, respectively. There was no acute toxicity of grade ≥3. One case of grade 3 late skin toxicity was reported 10 months after SBRT. Conclusion SBRT may be an effective and safe treatment modality for the local control of unresectable soft tissue tumors of the trunk including tumors of a benign nature.
Collapse
Affiliation(s)
- Eun Kyung Paik
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Chul-Koo Cho
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Hyung Jun Yoo
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Won Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Young-Seok Seo
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Sung-Ho Jin
- Department of Surgery, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Dae Geun Jeon
- Department of Orthopedic Surgery, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Dong Han Lee
- CyberKnife Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| |
Collapse
|
|
22
|
Barzilai O, Fisher CG, Bilsky MH. State of the Art Treatment of Spinal Metastatic Disease. Neurosurgery 2018; 82:757-769. [DOI: 10.1093/neuros/nyx567] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/23/2017] [Indexed: 12/25/2022] Open
Abstract
Abstract
Treatment paradigms for patients with spine metastases have evolved significantly over the past decade. Incorporating stereotactic radiosurgery into these paradigms has been particularly transformative, offering precise delivery of tumoricidal radiation doses with sparing of adjacent tissues. Evidence supports the safety and efficacy of radiosurgery as it currently offers durable local tumor control with low complication rates even for tumors previously considered radioresistant to conventional radiation. The role for surgical intervention remains consistent, but a trend has been observed toward less aggressive, often minimally invasive, techniques. Using modern technologies and improved instrumentation, surgical outcomes continue to improve with reduced morbidity. Additionally, targeted agents such as biologics and checkpoint inhibitors have revolutionized cancer care, improving both local control and patient survivals. These advances have brought forth a need for new prognostication tools and a more critical review of long-term outcomes. The complex nature of current treatment schemes necessitates a multidisciplinary approach including surgeons, medical oncologists, radiation oncologists, interventionalists, and pain specialists. This review recapitulates the current state-of-the-art, evidence-based data on the treatment of spinal metastases, integrating these data into a decision framework, NOMS, which integrates the 4 sentinel decision points in metastatic spine tumors: Neurologic, Oncologic, Mechanical stability, and Systemic disease and medical co-morbidities.
Collapse
Affiliation(s)
- Ori Barzilai
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Charles G Fisher
- Division of Spine, Department of Orthopedics, University of British Columbia, and the Combined Neurosurgical and Orthopedic Spine Program at Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Mark H Bilsky
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| |
Collapse
|
|
23
|
Bishop AJ, Tao R, Guadagnolo BA, Allen PK, Rebueno NC, Wang XA, Amini B, Tatsui CE, Rhines LD, Li J, Chang EL, Brown PD, Ghia AJ. Spine stereotactic radiosurgery for metastatic sarcoma: patterns of failure and radiation treatment volume considerations. J Neurosurg Spine 2017. [DOI: 10.3171/2017.1.spine161045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEGiven the relatively lower radiosensitivity of sarcomas and the locally infiltrative patterns of spread, the authors sought to investigate spine stereotactic radiosurgery (SSRS) outcomes for metastatic sarcomas and to analyze patterns of failure.METHODSThe records of 48 patients with 66 sarcoma spinal metastases consecutively treated with SSRS between 2002 and 2013 were reviewed. The Kaplan-Meier method was used to estimate rates of overall survival (OS) and local control (LC). Local recurrences were categorized as occurring infield (within the 95% isodose line [IDL]), marginally (between the 20% and 95% IDLs), or out of field.RESULTSMedian follow-up time was 19 months (range 1–121 months), and median age was 53 years (range 17–85 years). The most commonly treated histology was leiomyosarcoma (42%). Approximately two-thirds of the patients were treated with definitive SSRS (44 [67%]) versus postoperatively (22 [33%]). The actuarial 1-year OS and LC rates were 67% and 81%, respectively. Eighteen patients had a local relapse, which was more significantly associated with postoperative SSRS (p = 0.04). On multivariate modeling, receipt of postoperative SSRS neared significance for poorer LC (p = 0.06, subhazard ratio [SHR] 2.33), while only 2 covariates emerged as significantly correlated with LC: 1) biological equivalent dose (BED) > 48 Gy (vs BED ≤ 48 Gy, p = 0.006, SHR 0.21) and 2) single vertebral body involvement (vs multiple bodies, p = 0.03, SHR 0.27). Of the 18 local recurrences, 14 (78%) occurred at the margin, and while the majority of these cases relapsed within the epidural space, 4 relapsed within the paraspinal soft tissue. In addition, 1 relapse occurred out of field. Finally, the most common acute toxicity was fatigue (15 cases), with few late toxicities (4 insufficiency fractures, 3 neuropathies).CONCLUSIONSFor metastatic sarcomas, SSRS provides durable tumor control with minimal toxicity. High-dose single-fraction regimens offer optimal LC, and given the infiltrative nature of sarcomas, when paraspinal soft tissues are involved, larger treatment volumes may be warranted.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Claudio E. Tatsui
- 5Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Laurence D. Rhines
- 5Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Jing Li
- Departments of 1Radiation Oncology,
| | - Eric L. Chang
- 6Department of Radiation Oncology, USC Norris Cancer Hospital, Keck School of Medicine of USC, Los Angeles, California
| | | | | |
Collapse
|
|
24
|
Chou D, Bilsky MH, Luzzati A, Fisher CG, Gokaslan ZL, Rhines LD, Dekutoski MB, Fehlings MG, Ghag R, Varga P, Boriani S, Germscheid NM, Reynolds JJ, _ _. Malignant peripheral nerve sheath tumors of the spine: results of surgical management from a multicenter study. J Neurosurg Spine 2017; 26:291-298. [DOI: 10.3171/2016.8.spine151548] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Malignant peripheral nerve sheath tumors (MPNSTs) are rare soft-tissue sarcomas. Resection is the mainstay of treatment and the most important prognostic factor. However, complete resection of spinal MPNSTs with tumor-free margins is challenging due to the likelihood of residual tumor cells. The objective of this study was to describe whether the type of Enneking resection in the management of spinal MPNSTs had an effect on local recurrence and survival.
METHODS
The AOSpine Knowledge Forum Tumor developed a multicenter database that includes demographic, diagnostic, therapeutic, local recurrence, and survival data on patients with primary spinal column tumors. Patients who had undergone surgery for a primary spinal MPNST were included and were analyzed in 2 groups: 1) those undergoing Enneking appropriate (EA) resections and 2) those undergoing Enneking inappropriate (EI) resections. EA surgery was performed if there was histopathological evidence of an intact tumor pseudocapsule and at least a marginal resection on a vital structure. EI surgery was performed if there was an intentional or inadvertent transgression of the margin.
RESULTS
Between 1993 and 2012, 29 primary spine MPNSTs were identified in 12 (41%) females and 17 (59%) males with a mean age at diagnosis of 40 ± 17 years (range 5–74 years). The median patient follow-up was 1.3 years (range 42 days to 11.2 years). In total, 14 (48%) patients died and 14 (48%) patients suffered a local recurrence, 10 (71%) of whom died. Within 2 years after surgery, the median survival and local recurrence were not achieved. Data about Enneking appropriateness of surgery were available for 27 patients; 9 (33%) underwent an EA procedure and 18 (67%) underwent an EI procedure. Enneking appropriateness did not have a significant influence on local recurrence or survival. Twenty-two patients underwent adjuvant treatment with combined chemo- and radiotherapy (n = 7), chemotherapy alone (n = 3), or radiotherapy alone (n = 12). Adjuvant therapy had no significant influence on recurrence or survival.
CONCLUSIONS
The rates of recurrence and survival were similar for spinal MPNSTs regardless of whether patients had an EA or EI resection or received adjuvant therapy. Other factors such as variability of pathologist interpretation, PET CT correlation, or neurofibromatosis Type 1 status may play a role in patient outcome. Nonetheless, MPNSTs should still be treated as sarcomas until further evidence is known. The authors recommend an individualized approach with careful multidisciplinary decision making, and the patient should be informed about the morbidity of en bloc surgery when considering MPNST resection.
Collapse
Affiliation(s)
- Dean Chou
- 1Department of Neurosurgery, University of California, San Francisco, California
| | - Mark H. Bilsky
- 2Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Charles G. Fisher
- 4Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Ziya L. Gokaslan
- 5Department of Neurosurgery, Brown University, Providence, Rhode Island
| | | | | | | | - Ravi Ghag
- 4Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Peter Varga
- 9Department of Orthopedics, National Center for Spinal Disorders, Budapest, Hungary
| | - Stefano Boriani
- 10Department of Orthopedics, The Rizzoli Institute, Bologna, Italy
| | | | - Jeremy J. Reynolds
- 12Department of Orthopaedics, Oxford University Hospitals, Oxford, United Kingdom
| | | |
Collapse
|
|
25
|
Bian C, Chen N, Li XL, Zhou XG, Lin H, Jiang LB, Liu WM, Chen Q, Dong J. Surgery Combined with Radiotherapy to Treat Spinal Tumors: A Review of Published Reports. Orthop Surg 2017; 8:97-104. [PMID: 27384717 DOI: 10.1111/os.12230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/07/2016] [Indexed: 12/11/2022] Open
Abstract
Spinal tumors result in high morbidity and a high rate of lower limb paralysis. Both surgical therapy and radiation therapy (RT) are used to treat spinal tumors; however, how best to combine these two therapies to maximize the benefits and minimize the risks is still being debated. It is also difficult to decide the optimal timing, course and dose of RT, especially in pregnant women and children. The aim of this review is to assist surgeons who are dealing with spinal tumors by providing comprehensive information about advanced techniques for administering RT with greater precision and safety, and about the impact of various ways of combining surgery and RT on therapeutic outcomes. We here review published reports about treating spinal tumors with a combination of these two forms of therapy and attempt to draw appropriate conclusions concerning selection of optimal treatment protocols. Our conclusion is that postoperative radiotherapy, especially with high-precision, low-dose and multiple fractions, and brachytherapy are promising therapies to combined with surgery.
Collapse
Affiliation(s)
- Chong Bian
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nong Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai, China
| | - Xi-Lei Li
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Gang Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Bo Jiang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wang-Mi Liu
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qian Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
|
26
|
Radiation Therapy for Sarcomas. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
|
27
|
Miller JA, Balagamwala EH, Angelov L, Suh JH, Djemil T, Magnelli A, Qi P, Zhuang T, Godley A, Chao ST. Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Spinal Sarcomas. Technol Cancer Res Treat 2016; 16:276-284. [PMID: 27074915 DOI: 10.1177/1533034616643221] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Despite advancements in local and systemic therapy, metastasis remains common in the natural history of sarcomas. Unfortunately, such metastases are the most significant source of morbidity and mortality in this heterogeneous disease. As a classically radioresistant histology, stereotactic radiosurgery has emerged to control spinal sarcomas and provide palliation. However, there is a lack of data regarding pain relief and relapse following stereotactic radiosurgery. METHODS We queried a retrospective institutional database of patients who underwent spine stereotactic radiosurgery for primary and metastatic sarcomas. The primary outcome was pain relief following stereotactic radiosurgery. Secondary outcomes included progression of pain, radiographic failure, and development of toxicities following treatment. RESULTS Forty treatment sites were eligible for inclusion; the median prescription dose was 16 Gy in a single fraction. Median time to radiographic failure was 14 months. At 6 and 12 months, radiographic control was 63% and 51%, respectively. Among patients presenting with pain, median time to pain relief was 1 month. Actuarial pain relief at 6 months was 82%. Median time to pain progression was 10 months; at 12 months, actuarial pain progression was 51%. Following multivariate analysis, presence of neurologic deficit at consult (hazard ratio: 2.48, P < .01) and presence of extraspinal bone metastases (hazard ratio: 2.83, P < .01) were associated with pain relief. Greater pain at consult (hazard ratio: 1.92, P < .01), prior radiotherapy (hazard ratio: 4.65, P = .02), and greater number of irradiated vertebral levels were associated with pain progression. CONCLUSIONS Local treatment of spinal sarcomas has remained a challenge for decades, with poor rates of local control and limited pain relief following conventional radiotherapy. In this series, pain relief was achieved in 82% of treatments at 6 months, with half of patients experiencing pain progression by 12 months. Given minimal toxicity and suboptimal pain control at 12 months, dose escalation beyond 16 Gy is warranted.
Collapse
Affiliation(s)
- Jacob A Miller
- 1 Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Lilyana Angelov
- 3 Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA.,4 Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
| | - John H Suh
- 2 Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA.,3 Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Toufik Djemil
- 5 Department of Radiation Oncology, Cleveland Clinic Florida, Weston, FL, USA
| | - Anthony Magnelli
- 2 Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Peng Qi
- 2 Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Tingliang Zhuang
- 2 Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Godley
- 2 Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Samuel T Chao
- 2 Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA.,3 Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
|
28
|
Yang H, Cai BN, Wang XS, Cong XH, Xu W, Wang JY, Yang J, Xu SP, Ju ZJ, Ma L. Dose Evaluation of Fractionated Schema and Distance From Tumor to Spinal Cord for Spinal SBRT with Simultaneous Integrated Boost: A Preliminary Study. Med Sci Monit 2016; 22:598-607. [PMID: 26902177 PMCID: PMC4767138 DOI: 10.12659/msm.897146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/28/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study investigated and quantified the dosimetric impact of the distance from the tumor to the spinal cord and fractionation schemes for patients who received stereotactic body radiation therapy (SBRT) and hypofractionated simultaneous integrated boost (HF-SIB). MATERIAL AND METHODS Six modified planning target volumes (PTVs) for 5 patients with spinal metastases were created by artificial uniform extension in the region of PTV adjacent spinal cord with a specified minimum tumor to cord distance (0-5 mm). The prescription dose (biologic equivalent dose, BED) was 70 Gy in different fractionation schemes (1, 3, 5, and 10 fractions). For PTV V100, Dmin, D98, D95, and D1, spinal cord dose, conformity index (CI), V30 were measured and compared. RESULTS PTV-to-cord distance influenced PTV V100, Dmin, D98, and D95, and fractionation schemes influenced Dmin and D98, with a significant difference. Distances of ≥2 mm, ≥1 mm, ≥1 mm, and ≥0 mm from PTV to spinal cord meet dose requirements in 1, 3, 5, and 10 fractionations, respectively. Spinal cord dose, CI, and V30 were not impacted by PTV-to-cord distance and fractionation schemes. CONCLUSIONS Target volume coverage, Dmin, D98, and D95 were directly correlated with distance from the spinal cord for spine SBRT and HF-SIB. Based on our study, ≥2 mm, ≥1 mm, ≥1 mm, and ≥0 mm distance from PTV to spinal cord meets dose requirements in 1, 3, 5 and 10 fractionations, respectively.
Collapse
Affiliation(s)
- Hao Yang
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, P.R. China
- Department of Radiation Oncology, Inner Mongolia Cancer Hospital and The Affiliated People’s Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, P.R. China
| | - Bo-ning Cai
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Xiao-shen Wang
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Xiao-hu Cong
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Wei Xu
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Jin-yuan Wang
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Jun Yang
- Department of Oncology, First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, P.R. China
| | - Shou-ping Xu
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Zhong-jian Ju
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Lin Ma
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, P.R. China
- Department of Radiation Oncology, Hainan Branch of Chinese PLA General Hospital, Haitang Bay, Sanya, Hainan, P.R. China
| |
Collapse
|
|
29
|
Treating metastatic sarcomas locally: A paradoxe, a rationale, an evidence? Crit Rev Oncol Hematol 2015; 95:62-77. [DOI: 10.1016/j.critrevonc.2015.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/28/2014] [Accepted: 01/06/2015] [Indexed: 01/04/2023] Open
|
|
30
|
Bhattacharya I, Hoskin P. Stereotactic Body Radiotherapy for Spinal and Bone Metastases. Clin Oncol (R Coll Radiol) 2015; 27:298-306. [DOI: 10.1016/j.clon.2015.01.030] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/11/2015] [Accepted: 01/27/2015] [Indexed: 12/25/2022]
|
|
31
|
Bydon M, De la Garza-Ramos R, Bettagowda C, Gokaslan ZL, Sciubba DM. The use of stereotactic radiosurgery for the treatment of spinal axis tumors: A review. Clin Neurol Neurosurg 2014; 125:166-72. [DOI: 10.1016/j.clineuro.2014.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/31/2014] [Accepted: 08/03/2014] [Indexed: 12/25/2022]
|
|
32
|
Folkert MR, Tong WY, LaQuaglia MP, Wexler LH, Chou AJ, Magnan H, Zelefsky MJ, Wolden SL. 20-Year Experience With Intraoperative High-Dose-Rate Brachytherapy for Pediatric Sarcoma: Outcomes, Toxicity, and Practice Recommendations. Int J Radiat Oncol Biol Phys 2014; 90:362-8. [DOI: 10.1016/j.ijrobp.2014.06.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/20/2014] [Accepted: 06/04/2014] [Indexed: 11/27/2022]
|
|
33
|
Gerszten PC. Spine Metastases: From Radiotherapy, Surgery, to Radiosurgery. Neurosurgery 2014; 61 Suppl 1:16-25. [DOI: 10.1227/neu.0000000000000375] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Peter C. Gerszten
- Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
|
34
|
Clinical result of stereotactic radiosurgery for spinal metastasis from hepatocellular carcinoma: comparison with conventional radiation therapy. J Neurooncol 2014; 119:141-8. [DOI: 10.1007/s11060-014-1463-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 04/24/2014] [Indexed: 12/15/2022]
|
|
35
|
Chang UK, Lee DH, Kim MS. Stereotactic radiosurgery for primary malignant spinal tumors. Neurol Res 2014; 36:597-606. [DOI: 10.1179/1743132814y.0000000381] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
|
36
|
Harel R, Zach L. Spine radiosurgery for spinal metastases: indications, technique and outcome. Neurol Res 2014; 36:550-6. [DOI: 10.1179/1743132814y.0000000364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
|
37
|
Folkert MR, Bilsky MH, Tom AK, Oh JH, Alektiar KM, Laufer I, Tap WD, Yamada Y. Outcomes and Toxicity for Hypofractionated and Single-Fraction Image-Guided Stereotactic Radiosurgery for Sarcomas Metastasizing to the Spine. Int J Radiat Oncol Biol Phys 2014; 88:1085-91. [DOI: 10.1016/j.ijrobp.2013.12.042] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 12/18/2013] [Accepted: 12/25/2013] [Indexed: 10/25/2022]
|
|
38
|
Laufer I, Iorgulescu JB, Chapman T, Lis E, Shi W, Zhang Z, Cox BW, Yamada Y, Bilsky MH. Local disease control for spinal metastases following "separation surgery" and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. J Neurosurg Spine 2013; 18:207-14. [PMID: 23339593 DOI: 10.3171/2012.11.spine12111] [Citation(s) in RCA: 337] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Decompression surgery followed by adjuvant radiotherapy is an effective therapy for preservation or recovery of neurological function and achieving durable local disease control in patients suffering from metastatic epidural spinal cord compression (ESCC). The authors examine the outcomes of postoperative image-guided intensity-modulated radiation therapy delivered as single-fraction or hypofractionated stereotactic radiosurgery (SRS) for achieving long-term local tumor control. METHODS A retrospective chart review identified 186 patients with ESCC from spinal metastases who were treated with surgical decompression, instrumentation, and postoperative radiation delivered as either single-fraction SRS (24 Gy) in 40 patients (21.5%), high-dose hypofractionated SRS (24-30 Gy in 3 fractions) in 37 patients (19.9%), or low-dose hypofractionated SRS (18-36 Gy in 5 or 6 fractions) in 109 patients (58.6%). The relationships between postoperative adjuvant SRS dosing and fractionation, patient characteristics, tumor histology-specific radiosensitivity, grade of ESCC, extent of surgical decompression, response to preoperative radiotherapy, and local tumor control were evaluated by competing risks analysis. RESULTS The total cumulative incidence of local progression was 16.4% 1 year after SRS. Multivariate Gray competing risks analysis revealed a significant improvement in local control with high-dose hypofractionated SRS (4.1% cumulative incidence of local progression at 1 year, HR 0.12, p = 0.04) as compared with low-dose hypofractionated SRS (22.6% local progression at 1 year, HR 1). Although univariate analysis demonstrated a trend toward greater risk of local progression for patients in whom preoperative conventional external beam radiation therapy failed (22.2% local progression at 1 year, HR 1.96, p = 0.07) compared with patients who did not receive any preoperative radiotherapy (11.2% local progression at 1 year, HR 1), this association was not confirmed with multivariate analysis. No other variable significantly correlated with progression-free survival, including radiation sensitivity of tumor histology, grade of ESCC, extent of surgical decompression, or patient sex. CONCLUSIONS Postoperative adjuvant SRS following epidural spinal cord decompression and instrumentation is a safe and effective strategy for establishing durable local tumor control regardless of tumor histology-specific radiosensitivity. Patients who received high-dose hypofractionated SRS demonstrated 1-year local progression rates of less than 5% (95% CI 0%-12.2%), which were superior to the results of low-dose hypofractionated SRS. The local progression rate after single-fraction SRS was less than 10% (95% CI 0%-19.0%).
Collapse
Affiliation(s)
- Ilya Laufer
- Departments of Neurosurgery, Memorial Sloan–Kettering Cancer Center, New York, New York 10065, USA
| | | | | | | | | | | | | | | | | |
Collapse
|