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Rijken J, Crowe S, Trapp J, Kairn T. A review of stereotactic body radiotherapy for the spine. Phys Eng Sci Med 2020; 43:799-824. [DOI: 10.1007/s13246-020-00889-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
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Guerrero E, Ahmed M. The role of stereotactic ablative radiotherapy (SBRT) in the management of oligometastatic non small cell lung cancer. Lung Cancer 2015; 92:22-8. [PMID: 26775592 DOI: 10.1016/j.lungcan.2015.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 11/22/2015] [Indexed: 12/29/2022]
Abstract
Our understanding of metastatic disease has evolved significantly in the last 20 years. Considered strictly a systemic issue, local treatment would only have significant impact in terms of palliation. However, Hellman and Weichselbaum stated that there might be an intermediate state, in which controlling limited metastatic sites could improve oncologic outcomes. This is called an oligometastatic state, a point between locally confined cancer and widespread disease [1,2]. As treatment with chemotherapy alone for non small cell lung cancer (NSCLC) yields median survivals of 8-11 months [3] and minimal chances of long term survival, new strategies are needed to offer better odds for metastatic patients. Outcomes tend to be better in patients with low volume metastatic disease. [4,5], leading us to question whether the oligometastatic group of patients will gain from a more radical treatment paradigm. In this setting, ablative treatments like surgery or SBRT may provide longer survival and better local control times. There is a rationale for the use of ablative local treatments, as most failures after chemotherapy occur at sites initially affected by disease, and these sites could be a source of further dissemination. Also, chemotherapy resistance can adversely impact resolution of metastatic disease [6]. In rare cases, the abscopal effect (an immune effect arising after radiotherapy in non irradiated metastatic sites) has been described [7,8]. In this review article, we address the impact of SBRT in oligometastatic NSCLC, the most relevant prognostic factors, indications and a site specific review. This review will focus on SBRT for extracranial disease as the role for intracranial SBRT is established.
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Affiliation(s)
- Eduardo Guerrero
- Radiation Oncology Department, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Merina Ahmed
- Academic Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK.
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Stereotactic Body Radiotherapy of Bone Metastases in Oligometastatic Disease: Prognostic Factors of Oncologic Outcomes. TUMORI JOURNAL 2015; 102:59-64. [DOI: 10.5301/tj.5000441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 12/30/2022]
Abstract
Background To evaluate the safety of stereotactic body radiotherapy (SBRT) of bone metastases in oligometastatic disease and to investigate prognostic factors of local control (LC), progression/disease-free survival (PDFS), and overall survival (OS). Methods Eligibility criteria were number of metastates ≤5, controlled primary tumor without evidence of progression under systemic therapy, exclusion of surgery, and no previous radiotherapy of the lesion of interest. Oligometastatic status was classified into only bone (BOD) and outside bone disease (OBOD), whereas SBRT was delivered to bone lesions using 2 different schedules: 24 Gy/1 fraction or 27 Gy/3 fractions. A positron emission tomography study of the lesion of interest was performed at baseline and at 3 months after SBRT to evaluate metabolic response according to European Organization for Research and Treatment of Cancer (EORTC) criteria. A Cox regression model was used for univariate and multivariate analysis. Results Between January 2010 and December 2013, 40 patients were enrolled. Only 1 patient experienced severe late toxicity (radiation-related fracture). Local control was longer among responders’ than nonresponders’ lesions (94.2% and 91.2% versus 63% and 35% at 1 and 2 years, respectively) (p = 0.004; hazard ratio = 9.958). The multivariate analysis of PDFS showed a significant correlation with planning target volume (PTV) size (p = 0.003) and oligometastatic status (p = 0.002). The multivariate analysis of OS confirmed a statistically significant value of the oligometastatic status (p = 0.002) and a significant trend for PTV size (p = 0.065). Conclusions Stereotactic body radiotherapy is safe with a low incidence of severe toxicity. Positron emission tomography response was a strong prognostic factor of LC whereas BOD status and small PTV size could identify a subset of oligometastatic patients at better prognosis.
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Finnigan R, Burmeister B, Barry T, Jones K, Boyd J, Pullar A, Williams R, Foote M. Technique and early clinical outcomes for spinal and paraspinal tumours treated with stereotactic body radiotherapy. J Clin Neurosci 2015; 22:1258-63. [PMID: 25979254 DOI: 10.1016/j.jocn.2015.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/10/2015] [Accepted: 01/15/2015] [Indexed: 12/31/2022]
Abstract
We report technique and early clinical results of stereotactic body radiotherapy (SBRT) from Princess Alexandra Hospital. SBRT involves the precise delivery of highly conformal and image-guided external beam radiotherapy with high doses per fraction. It is increasingly being applied in management of spinal tumours. Thirty-six courses of spine SBRT in 34 patients were delivered between May 2010 and December 2013. Mean patient age was 58 years. Treatment was predominantly for metastatic disease, applied in de novo (n=22), retreatment (n=14) and postoperative (n=8) settings. Prescribed doses included 18-30 Gy in 1-5 fractions. SBRT technique evolved during the study period, resulting in a relative dose escalation. No severe acute toxicities were observed. At median follow-up of 7.4 months (range: 1.7-22.2), no late radiation myelopathy was observed. Risk of new/worsening vertebral compression fractures was 22% (n=8) and was significantly associated with increasing Spinal Instability Neoplastic Scores (p=0.0002). In-field control was 86% with relapse occurring at a median interval of 2.8 months (range: 1.9-4.7). Thirteen patients (36%) died and median overall survival has not been reached. SBRT is an evolving technology with promising early efficacy and safety results. The outcomes of this series are comparable with international literature, and await longer follow-up.
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Affiliation(s)
- Renee Finnigan
- Radiation Oncology Queensland, Southport, QLD, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Bryan Burmeister
- University of Queensland School of Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Tamara Barry
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Kimberley Jones
- Centre for Experimental Haematology, University of Queensland School of Medicine, Translational Research Institute, Woolloongabba, QLD, Australia
| | - Josh Boyd
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Andrew Pullar
- University of Queensland School of Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Richard Williams
- Department of Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Matthew Foote
- University of Queensland School of Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia.
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Lo SS, Fakiris AJ, Teh BS, Cardenes HR, Henderson MA, Forquer JA, Papiez L, McGarry RC, Wang JZ, Li K, Mayr NA, Timmerman RD. Stereotactic body radiation therapy for oligometastases. Expert Rev Anticancer Ther 2014; 9:621-35. [DOI: 10.1586/era.09.15] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
INTRODUCTION Irradiation of bone metastases primarily aims at alleviating pain, preventing fracture in the short term. The higher doses and more conformal dose distribution achievable while saving healthy tissue with new irradiation techniques have induced a paradigm shift in the management of bone metastases in a growing number of clinical situations. MATERIALS AND METHODS A search of the English and French literature was conducted using the keywords: bone metastases, radiotherapy, interventional radiology, vertebroplasty, radiofrequency, chemoembolization. RESULTS-DISCUSSION: Stereotactic irradiation yields pain relief rates greater than 90% in Phase I/II and retrospective studies. IMRT (static, rotational, helical) and stereotactic irradiation yield local control rates of 75-90% at 2 years. Some situations previously evaluated as palliative are currently treated more aggressively with optimized radiation sometimes combined modality interventional radiology. CONCLUSION A recommendation can only be made for stereotactic irradiation in vertebral oligometastases or reirradiation. In the absence of a sufficient level of evidence, the increasing use of conformal irradiation techniques can only reflect the daily practice and the patient benefit while integrating economic logic care. The impact of these aggressive approaches on survival remains to be formally demonstrated by interventional prospective studies or observatories including quality of life items and minimal 2-year follow-up.
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Thariat J, Leysalle A, Vignot S, Marcy PY, Lacout A, Bera G, Lagrange JL, Clezardin P, Chiras J. Traitement local ablatif de la maladie oligométastatique osseuse (hors chirurgie). Cancer Radiother 2012; 16:330-8. [DOI: 10.1016/j.canrad.2012.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
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Guckenberger M, Sweeney RA, Flickinger JC, Gerszten PC, Kersh R, Sheehan J, Sahgal A. Clinical practice of image-guided spine radiosurgery--results from an international research consortium. Radiat Oncol 2011; 6:172. [PMID: 22172095 PMCID: PMC3286433 DOI: 10.1186/1748-717x-6-172] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 12/15/2011] [Indexed: 03/10/2023] Open
Abstract
Background Spinal radiosurgery is a quickly evolving technique in the radiotherapy and neurosurgical communities. However, the methods of spine radiosurgery have not been standardized. This article describes the results of a survey about the methods of spine radiosurgery at five international institutions. Methods All institutions are members of the Elekta Spine Radiosurgery Research Consortium and have a dedicated research and clinical focus on image-guided radiosurgery. The questionnaire consisted of 75 items covering all major steps of spine radiosurgery. Results Strong agreement in the methods of spine radiosurgery was observed. In particular, similarities were observed with safety and quality assurance playing an important role in the methods of all institutions, cooperation between neurosurgeons and radiation oncologists in case selection, dedicated imaging for target- and organ-at-risk delineation, application of proper safety margins for the target volume and organs-at-risk, conformal planning and precise image-guided treatment delivery, and close clinical and radiological follow-up. In contrast, three major areas of uncertainty and disagreement were identified: 1) Indications and contra-indications for spine radiosurgery; 2) treatment dose and fractionation and 3) tolerance dose of the spinal cord. Conclusions Results of this study reflect the current practice of spine radiosurgery in large academic centers. Despite close agreement was observed in many steps of spine radiosurgery, further research in form of retrospective and especially prospective studies is required to refine the details of spinal radiosurgery in terms of safety and efficacy.
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Affiliation(s)
- Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany.
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Kirkpatrick JP, van der Kogel AJ, Schultheiss TE. Radiation Dose–Volume Effects in the Spinal Cord. Int J Radiat Oncol Biol Phys 2010; 76:S42-9. [PMID: 20171517 DOI: 10.1016/j.ijrobp.2009.04.095] [Citation(s) in RCA: 319] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 04/17/2009] [Accepted: 04/22/2009] [Indexed: 12/22/2022]
Affiliation(s)
- John P Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
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Lo SS, Fakiris AJ, Chang EL, Mayr NA, Wang JZ, Papiez L, Teh BS, McGarry RC, Cardenes HR, Timmerman RD. Stereotactic body radiation therapy: a novel treatment modality. Nat Rev Clin Oncol 2009; 7:44-54. [PMID: 19997074 DOI: 10.1038/nrclinonc.2009.188] [Citation(s) in RCA: 253] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiation therapy (SBRT) involves the delivery of a small number of ultra-high doses of radiation to a target volume using very advanced technology and has emerged as a novel treatment modality for cancer. The role of SBRT is most important at two cancer stages-in early primary cancer and in oligometastatic disease. This modality has been used in the treatment of early-stage non-small-cell lung cancer, prostate cancer, renal-cell carcinoma, and liver cancer, and in the treatment of oligometastases in the lung, liver, and spine. A large body of evidence on the use of SBRT for the treatment of primary and metastatic tumors in various sites has accumulated over the past 10-15 years, and efficacy and safety have been demonstrated. Several prospective clinical trials of SBRT for various sites have been conducted, and several other trials are currently being planned. The results of these clinical trials will better define the role of SBRT in cancer management. This article will review the radiobiologic, technical, and clinical aspects of SBRT.
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Affiliation(s)
- Simon S Lo
- Department of Radiation Oncology, Arthur G. James Cancer Hospital, Ohio State University College of Medicine, 300 West 10th Avenue, Columbus, OH 43210, USA.
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Guckenberger M, Goebel J, Wilbert J, Baier K, Richter A, Sweeney RA, Bratengeier K, Flentje M. Clinical Outcome of Dose-Escalated Image-Guided Radiotherapy for Spinal Metastases. Int J Radiat Oncol Biol Phys 2009; 75:828-35. [DOI: 10.1016/j.ijrobp.2008.11.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 11/03/2008] [Accepted: 11/08/2008] [Indexed: 11/16/2022]
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Chawla S, Abu-Aita R, Philip A, Lundquist T, Okunieff P, Milano MT. Stereotactic radiosurgery for spinal metastases: case report and review of treatment options. Bone 2009; 45:817-21. [PMID: 19540375 DOI: 10.1016/j.bone.2009.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 05/21/2009] [Accepted: 06/09/2009] [Indexed: 11/29/2022]
Abstract
The spine is the most common site for bone metastases. Spinal metastases can impact quality of life by causing severe pain, limitation of motion, and increased requirements for pain medication. Radiation therapy is a common form of treatment reserved for palliation of pain and for prevention or treatment of spinal cord compression. Newer approaches such as stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) have a more precise ability to customize the radiation dose to the target tissues adjacent to critical structures, thus increasing the local control of spinal column metastases. In this report, we examine the efficacy and possible advantages of single fraction SRS using a state-of-the-art tomotherapy machine in the treatment of a patient with spinal metastases from breast cancer. We also review the literature on treatment of spinal metastases using SRS, SBRT, and other modalities.
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Affiliation(s)
- Sheema Chawla
- University of Rochester Medical Center, Department of Radiation Oncology, 601 Elmwood Ave Box 647, Rochester, NY 14642, USA
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Nelson JW, Yoo DS, Sampson JH, Isaacs RE, Larrier NA, Marks LB, Yin FF, Wu QJ, Wang Z, Kirkpatrick JP. Stereotactic body radiotherapy for lesions of the spine and paraspinal regions. Int J Radiat Oncol Biol Phys 2008; 73:1369-75. [PMID: 19004569 DOI: 10.1016/j.ijrobp.2008.06.1949] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 06/13/2008] [Accepted: 06/20/2008] [Indexed: 02/08/2023]
Abstract
PURPOSE To describe our experience and clinical strategy for stereotactic body radiotherapy (SBRT) of spinal lesions. METHODS AND MATERIALS Thirty-two patients with 33 spinal lesions underwent computed tomography-based simulation while free breathing. Gross/clinical target volumes included involved portions of the vertebral body and paravertebral/epidural tumor. Planning target volume (PTV) expansion was 6 mm axially and 3 mm radially; the cord was excluded from the PTV. Biologic equivalent dose was calculated using the linear quadratic model with alpha/beta = 3 Gy. Treatment was linear accelerator based with on-board imaging; dose was adjusted to maintain cord dose within tolerance. Survival, local control, pain, and neurologic status were monitored. RESULTS Twenty-one patients are alive at 1 year (median survival, 14 months). Median follow-up is 6 months for all patients (7 months for survivors). Mean previous radiotherapy dose to 22 patients was 35 Gy, and median interval was 17 months. Renal (31%), breast, and lung (19% each) were the most common histologic sites. Three SBRT fractions (range, one to four fractions) of 7 Gy (range, 5-16 Gy) were delivered. Median cord and target biologic equivalent doses were 70 Gy(3) and 34.3 Gy(10), respectively. Thirteen patients reported complete and 17 patients reported partial pain relief at 1 month. There were four failures (mean, 5.8 months) with magnetic resonance imaging evidence of in-field progression. No dosimetric parameters predictive of failure were identified. No treatment-related toxicity was seen. CONCLUSIONS Spinal SBRT is effective in the palliative/re-treatment setting. Volume expansion must ensure optimal PTV coverage while avoiding spinal cord toxicity. The long-term safety of spinal SBRT and the applicability of the linear-quadratic model in this setting remain to be determined, particularly the time-adjusted impact of prior radiotherapy.
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Affiliation(s)
- John W Nelson
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
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Sahgal A, Larson DA, Chang EL. Stereotactic body radiosurgery for spinal metastases: a critical review. Int J Radiat Oncol Biol Phys 2008; 71:652-65. [PMID: 18514775 DOI: 10.1016/j.ijrobp.2008.02.060] [Citation(s) in RCA: 210] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 02/06/2008] [Accepted: 02/13/2008] [Indexed: 12/13/2022]
Affiliation(s)
- Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
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