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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: 0] [Impact Index Per Article: 0] [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.
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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.
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McClelland S, Sun Y, Spratt DE. Spine Patient Optimal Radiosurgery Treatment for Symptomatic Metastatic Neoplasms (SPORTSMEN): a randomized phase II study protocol. Rep Pract Oncol Radiother 2023; 28:379-388. [PMID: 37795393 PMCID: PMC10547410 DOI: 10.5603/rpor.a2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/05/2023] [Indexed: 10/06/2023] Open
Abstract
Background Approximately 40% of patients with metastatic cancer will have spinal metastatic disease. Historically treated with external beam radiation therapy (EBRT) with limited durability in pain control, the increased lifespan of this patient population has necessitated more durable treatment results via spine radiosurgery/stereotactic body radiation therapy (SBRT). The goal of this study is to assess three-month pain freedom rates via the Spine Patient Optimal Radiosurgery Treatment for Symptomatic Metastatic Neoplasms (SPORTSMEN) randomized trial. Materials and methods This study is a prospective randomized three-arm phase II trial which will recruit patients with symptomatic spine metastases. All patients will be randomized to standard-of care SBRT (24 Gy in 2 fractions), single-fraction SBRT (19 Gy in 1 fraction), or EBRT (8 Gy in 1 fraction), with the primary endpoint of three-month pain freedom (using the Brief Pain Inventory). We expect that SPORTSMEN will help definitively answer the efficacy of spine SBRT versus EBRT for achieving pain freedom, while defining the safety and efficacy of 19 Gy single-fraction spine SBRT. Local control will be defined according to Spine Response Assessment in Neuro-Oncology (SPINO) criteria. Discussion This is the first phase II trial to objectively assess optimal spine SBRT dosing in the treatment of symptomatic spine metastatic disease, while assessing spine SBRT versus EBRT. Findings should allow for better determination of the efficacy of two-fraction spine SBRT versus EBRT in the United States, as well as for the novel single-fraction 19 Gy spine SBRT regimen in patients with symptomatic spine metastases. Trial Registration Clinicaltrials.gov identifier: NCT05617716 (registration date: November 14, 2022).
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Department of Neurological Surgery, University Hospitals Seidman Cancer Center Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Yilun Sun
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Daniel E. Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center Case Western Reserve University School of Medicine, Cleveland, OH, United States
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Kang DH, Chang BS, Kim H, Hong SH, Chang SY. Separation surgery followed by stereotactic ablative radiotherapy for metastatic epidural spinal cord compression: A systematic review and meta-analysis for local progression rate. J Bone Oncol 2022; 36:100450. [PMID: 35990514 PMCID: PMC9386097 DOI: 10.1016/j.jbo.2022.100450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/22/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
The pooled 1-year local progression rate of hybrid therapy in spinal metastasis was 10.2%. The pooled 2-year local progression rate of hybrid therapy in spinal metastasis was 13.7%. A lower radiation dose per fraction showed a significant association with the 1-year local progression rate of hybrid therapy in spinal metastasis. History of prior radiotherapy showed a significant association with the 1-year local progression rate of hybrid therapy in spinal metastasis. Colorectal cancer showed a significant association with the 1-year local progression rate of hybrid therapy in spinal metastasis.
Introduction Spinal metastasis is the most common metastatic skeletal disease in cancer patients. Metastatic epidural spinal cord compression (MESCC), which occurs in 5–14% of cancer patients, is an oncological emergency because it may cause a permanent neurological deficit. Separation surgery followed by stereotactic ablative radiotherapy (SABR), so-called “hybrid therapy,” has shown effectiveness in local control of spinal metastasis and has become an integral treatment option for patients with MESCC. Therefore, we performed a meta-analysis and meta-regression analysis to clarify the local progression rate of hybrid therapy and the risk factors for local progression. Methods We searched PubMed, EMBASE, Scopus, Cochrane Library, and Web of Science databases from inception to December 2021. Meta-analyses of proportions were used to analyze the data using a random-effects model to calculate the pooled 1-year local progression rate and confidence interval. Subgroup analyses were performed using meta-analyses of odds ratio (OR) for comparisons between groups. We also conducted a meta-regression analysis to identify the factors that caused heterogeneity. Results A total of 661 patients from 13 studies (10 retrospective and 3 prospective) were included in the final meta-analysis. The quality of the included studies assessed using the Newcastle − Ottawa scale ranged from poor to fair (range, 4–6). The pooled local progression rate was 10.2 % (95 % confidence interval [CI], 7.8–12.8 %; I2 = 30 %) and 13.7 % (95 % CI, 9.3–18.8 %; I2 = 55 %) at postoperative 1 and 2 years, respectively. The subgroup analysis indicated that patients with a history of prior radiotherapy (OR, 5.14; 95 % CI, 1.71–15.51) and lower radiation dose per fraction (OR, 4.57; 95 % CI, 1.88–11.13) showed significantly higher pooled 1-year local progression rates. In the moderator analysis, the 1-year local progression rate was significantly associated with the proportion of patients with a history of prior radiotherapy (p = 0.036) and those with colorectal cancer as primary origin (p < 0.001). Conclusions The pooled 1-year local progression rate of hybrid therapy for MESCC was 10.2%. In subgroup and moderator analyses, a lower radiation dose per fraction, history of prior radiotherapy, and colorectal cancer showed a significant association with the 1-year local progression rate.
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Key Words
- CT, computed tomography
- CTV, clinical target volume
- GTV, gross tumor volume
- Gy, Gray
- Hybrid therapy
- Local progression
- MESCC, metastatic epidural spinal cord compression
- MOOSE, Meta-Analysis of Observational Studies in Epidemiology
- MRI, magnetic resonance imaging
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- PTV, planning target volume
- Radioresistance
- SABR, stereotactic ablative radiotherapy
- Separation surgery
- Spinal metastasis
- Stereotactic ablative radiotherapy
- cEBRT, conventional external beam radiation therapy
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Affiliation(s)
- Dong-Ho Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Hyoungmin Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Seong Hwa Hong
- Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Sam Yeol Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
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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: 2.3] [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.
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Makita K, Hamamoto Y, Kanzaki H, Kataoka M, Yamamoto S, Nagasaki K, Ishikawa H, Takata N, Tsuruoka S, Uwatsu K, Kido T. Local control of bone metastases treated with external beam radiotherapy in recent years: a multicenter retrospective study. Radiat Oncol 2021; 16:225. [PMID: 34801042 PMCID: PMC8605549 DOI: 10.1186/s13014-021-01940-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Over the past decades, remarkable advancements in systemic drug therapy have improved the prognosis of patients with bone metastases. Individualization is required in external beam radiotherapy (EBRT) for bone metastases according to the patient's prognosis. To establish individualized EBRT for bone metastases, we investigated factors that affect the local control (LC) of bone metastases. METHODS Between January 2010 and December 2019, 536 patients received EBRT for 751 predominantly osteolytic bone metastases. LC at EBRT sites was evaluated with a follow-up computed tomography. The median EBRT dose was biologically effective dose (BED10) (39.0) (range of BED10: 14.4-71.7 Gy). RESULTS The median follow-up time and median time of computed tomography follow-up were 11 (range 1-123) months and 6 (range 1-119) months, respectively. The 0.5- and 1-year overall survival rates were 73% and 54%, respectively. The 0.5- and 1-year LC rates were 83% and 79%, respectively. In multivariate analysis, higher age (≥ 70 years), non-vertebral bone metastases, unfavorable primary tumor sites (esophageal cancer, colorectal cancer, hepatobiliary/pancreatic cancer, renal/ureter cancer, sarcoma, melanoma, and mesothelioma), lower EBRT dose (BED10 < 39.0 Gy), and non-administration of bone-modifying agents (BMAs)/antineoplastic agents after EBRT were significantly unfavorable factors for LC of bone metastases. There was no statistically significant difference in the LC between BED10 = 39.0 and BED10 > 39.0 Gy. CONCLUSIONS Regarding tumor-related factors, primary tumor sites and the sites of bone metastases were significant for the LC. As for treatment-related factors, lower EBRT doses (BED10 < 39.0 Gy) and non-administration of BMAs/antineoplastic agents after EBRT were associated with poor LC. Dose escalation from BED10 = 39.0 Gy did not necessarily improve LC.
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Affiliation(s)
- Kenji Makita
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan.
- Department of Radiology, Saiseikai Imabari Hospital, 7-1-6 Kita-machi, Imabari, Ehime, 799-1592, Japan.
| | - Yasushi Hamamoto
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Hiromitsu Kanzaki
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Masaaki Kataoka
- Department of Radiology, Saiseikai Imabari Hospital, 7-1-6 Kita-machi, Imabari, Ehime, 799-1592, Japan
| | - Shuhei Yamamoto
- Department of Radiology, Saiseikai Imabari Hospital, 7-1-6 Kita-machi, Imabari, Ehime, 799-1592, Japan
| | - Kei Nagasaki
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Hirofumi Ishikawa
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Noriko Takata
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Shintaro Tsuruoka
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kotaro Uwatsu
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
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Radiation Therapy in Metastatic Soft Tissue Sarcoma: From Palliation to Ablation. Cancers (Basel) 2021; 13:cancers13194775. [PMID: 34638260 PMCID: PMC8508247 DOI: 10.3390/cancers13194775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary In the United States, over 13,000 patients are diagnosed with soft tissue sarcoma annually leading to over 5000 deaths per year despite aggressive treatments including radiotherapy, surgery, and chemotherapy. Although the majority of patients present with localized disease, unfortunately many will develop metastatic disease, which is generally not curable. There is growing evidence that local ablative therapies may be beneficial in patients with a variety of metastatic malignancies. In this review article, we explore the evolving role of radiotherapy in patients with metastatic soft tissue sarcoma. In particular, we review the growing role of ablative radiotherapy for oligometastatic disease, local control of the primary site, and palliation. Abstract The management of patients with metastatic cancer is rapidly changing. Historically, radiotherapy was utilized for the treatment of localized disease or for palliation. While systemic therapy remains the mainstay of management for patients with metastatic cancer, radiotherapy is becoming increasingly important not only to palliate symptoms, but also to ablate oligometastatic or oligoprogressive disease and improve local control in the primary site. There is emerging evidence in multiple solid malignancies that patients with low volume metastatic disease that undergo local ablative therapy to metastatic sites may have improved progression free survival and potentially overall survival. In addition, there is increasing evidence that select patients with metastatic disease may benefit from aggressive treatment of the primary site. Patients with metastatic soft tissue sarcoma have a poor overall prognosis. However, there may be opportunities in patients with low volume metastatic soft tissue sarcoma to improve outcomes with local therapy including surgery, ablation, embolization, and radiation therapy. Stereotactic body radiation therapy (SBRT) offers a safe, convenient, precise, and non-invasive option for ablation of sites of metastases. In this review article, we explore the limited yet evolving role of radiotherapy to metastatic and primary sites for local control and palliation, particularly in the oligometastatic setting.
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Chen JJ, Sullivan AJ, Shi DD, Krishnan MS, Hertan LM, Roldan CS, Huynh MA, Spektor A, Fareed MM, Lam TC, Balboni TA. Characteristics and Predictors of Radiographic Local Failure in Patients With Spinal Metastases Treated With Palliative Conventional Radiation Therapy. Adv Radiat Oncol 2021; 6:100665. [PMID: 33817411 PMCID: PMC8010570 DOI: 10.1016/j.adro.2021.100665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/18/2020] [Accepted: 01/24/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose Although local control is an important issue for longer-term survivors of spinal metastases treated with conventional external beam radiation therapy (EBRT), the literature on radiographic local failure (LF) in these patients is sparse. To inform clinical decision-making, we evaluated rates, consequences, and predictors of radiographic LF in patients with spinal metastases managed with palliative conventional EBRT alone. Methods and Materials We retrospectively reviewed 296 patients with spinal metastases who received palliative EBRT at a single institution (2006-2013). Radiographic LF was defined as radiologic progression within the treatment field, with death considered a competing risk. Kaplan-Meier, cumulative incidence, and Cox regression analyses determined overall survival estimates, LF rates, and predictors of LF, respectively. Results There were 182 patients with follow-up computed tomography or magnetic resonance imaging; median overall survival for these patients was 7.7 months. Patients received a median of 30 Gy in 10 fractions to a median of 4 vertebral bodies. Overall, 74 of 182 patients (40.7%) experienced LF. The 6-, 12-, and 18-month LF rates were 26.5%, 33.1%, and 36.5%, respectively, while corresponding rates of death were 24.3%, 38.1%, and 45.9%. Median time to LF was 3.8 months. Of those with LF, 51.4% had new compression fractures, 39.2% were admitted for pain control, and 35.1% received reirradiation; median time from radiation therapy (RT) to each of these events was 3.0, 5.7, and 9.2 months, respectively. Independent predictors of LF included single-fraction RT (8 Gy) (hazard ratio [HR], 2.592; 95% confidence interval [CI], 1.437-4.675; P = .002), lung histology (HR, 3.568; 95% CI, 1.532-8.309; P = .003), and kidney histology (HR, 4.937; 95% CI, 1.529-15.935; P = .008). Conclusions Patients experienced a >30% rate of radiographic LF by 1 year after EBRT. Single-fraction RT and lung or kidney histology predicted LF. Given the high rates of LF for patients with favorable prognosis, assessing the risk of death versus LF is important for clinical decision-making.
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Affiliation(s)
- Jie Jane Chen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Adam J. Sullivan
- Department of Biostatistics, Brown University, Providence, Rhode Island
| | - Diana D. Shi
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Monica S. Krishnan
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Lauren M. Hertan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Claudia S. Roldan
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Mai Anh Huynh
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Alexander Spektor
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - M. Mohsin Fareed
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Tai Chung Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tracy A. Balboni
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Cancer Center, Boston, Massachusetts
- Corresponding author: Tracy A. Balboni, MD, MPH
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Zeng KL, Sahgal A, Husain ZA, Myrehaug S, Tseng CL, Detsky J, Sarfehnia A, Ruschin M, Campbell M, Foster M, Das S, Lipsman N, Bjarnason GA, Atenafu EG, Maralani PJ, Soliman H. Local control and patterns of failure for "Radioresistant" spinal metastases following stereotactic body radiotherapy compared to a "Radiosensitive" reference. J Neurooncol 2021; 152:173-182. [PMID: 33453002 DOI: 10.1007/s11060-020-03691-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/30/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The concept of a radioresistant (RR) phenotype has been challenged with use of stereotactic body radiotherapy (SBRT). We compared outcomes following SBRT to RR spinal metastases to a radiosensitive cohort. METHODS Renal cell, melanoma, sarcoma, gastro-intestinal, and thyroid spinal metastases were identified as RR and prostate cancer (PCA) as radiosensitive. The primary endpoint was MRI-based local failure (LF). Secondary endpoints included overall survival (OS) and vertebral compression fracture (VCF). RESULTS From a prospectively maintained database of 1394 spinal segments in 605 patients treated with spine SBRT, 173 patients/395 RR spinal segments were compared to 94 patients/185 PCA segments. Most received 24-28 Gy in 2 fractions (68.9%) and median follow-up was 15.5 months (range, 1.4-84.2 months). 1- and 2-year LF rates were 19.2% and 22.4% for RR metastases, respectively, which were significantly greater (p < 0.001) than PCA (3.2% and 8.4%, respectively). Epidural disease (HR: 2.47, 95% CI 1.65-3.71, p < 0.001) and RR histology (HR: 2.41, 95% CI 1.45-3.99, p < 0.001) predicted for greater LF. Median OS was 17.4 and 61.0 months for RR and PCA cohorts, respectively. Lung/liver metastases, polymetastatic disease and epidural disease predicted for worse OS. 2-year VCF rates were ~ 13% in both cohorts. Coverage of the CTV V90 (clinical target volume receiving 90% of prescription dose) by ≥ 87% (HR: 2.32, 95% CI 1.29-4.18, p = 0.005), no prior spine radiotherapy (HR: 1.96, 95% CI 1.09-3.55, p = 0.025), and a greater Spinal Instability Neoplasia Score (p = 0.013) predicted for VCF. CONCLUSIONS Higher rates of LF were observed after spine SBRT in RR metastases. Optimization strategies include dose escalation and aggressive management of epidural disease.
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Affiliation(s)
- K Liang Zeng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Zain A Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Arman Sarfehnia
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Mikki Campbell
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Monica Foster
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Sunit Das
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Georg A Bjarnason
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Pejman Jabehdar Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada.
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Ito K, Yamaguchi T, Ogawa H, Nakajima Y, Karasawa K. Stereotactic body radiotherapy for bone metastases in patients with colorectal cancer. Jpn J Clin Oncol 2021; 50:1442-1446. [PMID: 32719860 DOI: 10.1093/jjco/hyaa128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/29/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To clarify the clinical outcomes of stereotactic body radiotherapy for colorectal cancer-derived bone metastases and identify factors predicting treatment failure. METHODS Patients treated with stereotactic body radiotherapy for bone metastases from colorectal cancer between September 2013 and June 2019 were retrospectively reviewed. The prescribed dose for spine and non-spine bone metastases was 24 Gy in two fractions and 35 Gy in five fractions, respectively. The end point was local failure, which was defined as tumour progression on imaging evaluations. In addition, various treatment- and tumour-specific factors were evaluated to determine predictors of local failure. RESULTS This study included 43 lesions in 38 patients, with solitary bone metastases in 18 lesions (42%), re-irradiation stereotactic body radiotherapy in 28 lesions (65%) and postoperative stereotactic body radiotherapy due to spinal cord compression in 10 lesions (23%). The median follow-up after stereotactic body radiotherapy was 12 (range, 2-60) months. The 1-year LF rate was 44%. In the univariate analysis, sacral metastases (P = 0.02) were found to be significantly correlated with LF, and multiple-course systemic therapy before stereotactic body radiotherapy (P= 0.06) and large target volume (P = 0.07) showed a trend towards an association with LF. However, these factors were not independent predictors of LF in the multivariate analysis. CONCLUSION More than 40% of the lesions treated with stereotactic body radiotherapy for bone metastases from colorectal cancer showed LF within 1 year. No poor prognostic factors could be identified statistically. The poor outcomes in all groups indicate that the treatment intensity of the stereotactic body radiotherapy was insufficient to control colorectal cancer bone metastases.
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Affiliation(s)
- Kei Ito
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo
| | - Tatsuro Yamaguchi
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hiroaki Ogawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo
| | - Yujiro Nakajima
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo
| | - Katsuyuki Karasawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo
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10
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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
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11
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The Evolving Role of Radiation Therapy in Patients with Metastatic Soft Tissue Sarcoma. Curr Oncol Rep 2020; 22:79. [DOI: 10.1007/s11912-020-00936-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Schaefer IM, Hong K, Kalbasi A. How Technology Is Improving the Multidisciplinary Care of Sarcoma. Am Soc Clin Oncol Educ Book 2020; 40:445-462. [PMID: 32421448 PMCID: PMC8009691 DOI: 10.1200/edbk_280729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Sarcomas are rare tumors but comprise a wide histologic spectrum. Advances in technology have emerged to address the biologic complexity and challenging diagnosis and treatment of this disease. The diagnostic approach to sarcomas has historically been based on morphologic features, but technologic advances in immunohistochemistry and cytogenetic/molecular testing have transformed the interdisciplinary work-up of mesenchymal neoplasms in recent years. On the therapeutic side, technologic advances in the delivery of radiation have made it a linchpin in the treatment of localized and oligometastatic sarcoma. In this review, we discuss recent advances in the pathologic diagnosis of sarcomas and discuss select sarcoma types that illustrate how newly discovered diagnostic, prognostic, and predictive biomarkers have refined existing classification schemes and substantially shaped our diagnostic approach. Such examples include conventional and epithelioid malignant peripheral nerve sheath tumors (MPNSTs), emerging entities in the group of round cell sarcomas, and other mesenchymal neoplasms with distinct cytogenetic aberrations. Recent advances in radiation oncology, including intensity-modulated, stereotactic, MRI-guided, and proton radiotherapy (RT), will be reviewed in the context of neoadjuvant or adjuvant localized soft-tissue sarcoma and oligometastatic or oligoprogressive disease. Innovations in translational research are expected to be introduced into clinical practice over the next few years and will likely continue to affect the rapidly evolving field of sarcoma diagnostics and therapy.
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Affiliation(s)
- Inga-Marie Schaefer
- Department of Pathology, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA
| | - Kelvin Hong
- Division of Vascular & Interventional Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Anusha Kalbasi
- Division of Molecular and Cellular Oncology, Department of Radiation Oncology, Jonsson Comprehensive Cancer Center Sarcoma Program, University of California Los Angeles, Los Angeles, CA
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13
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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: 0.8] [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.
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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
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14
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Loi M, Nuyttens JJ, Desideri I, Greto D, Livi L. Single-Fraction Radiotherapy (SFRT) For Bone Metastases: Patient Selection And Perspectives. Cancer Manag Res 2019; 11:9397-9408. [PMID: 31807069 PMCID: PMC6842277 DOI: 10.2147/cmar.s186630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/22/2019] [Indexed: 01/02/2023] Open
Abstract
Bone metastases are a frequent and important source of morbidity in cancer patients. Stereotactic body radiation therapy (SBRT) is an established treatment option for local control and pain relief of bone metastases, and it is increasingly used as upfront treatment, postoperative consolidation or salvage treatment after prior RT. However, heterogeneity of dose schedules described in literature represents a severe limitation in the definition of the role of SBRT as a standard of care. No consensus is available on the use of single versus multiple fraction SBRT for bone metastases. Advantages of single-fraction SBRT include shorter overall duration of treatment, absence of inter-fraction uncertainty, improved compliance, theoretical increased efficacy, and lower costs. However, caution has been advised due to reports of severe late toxicities, in particular, vertebral collapse fracture (VCF). The aim of this paper is to review dose fractionation and indications for the management of bone metastases using SBRT.
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Affiliation(s)
- Mauro Loi
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Joost J Nuyttens
- Radiotherapy Department, Erasmus MC Cancer Center, Rotterdam, The Netherlands
| | - Isacco Desideri
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Daniela Greto
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiotherapy Department, University of Florence, Florence, Italy
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15
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Moussalem CK, Massaad E, Baassiri W, Akhtar Anwar M, Kobeissy F, Eid A, Darwiche N, Omeis I. Spinal sarcomas and immunity: An undervalued relationship. Semin Cancer Biol 2019; 64:36-50. [PMID: 31254615 DOI: 10.1016/j.semcancer.2019.06.009] [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: 01/08/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 11/17/2022]
Abstract
Sarcomas, especially spine sarcomas, are rare yet debilitating and are underestimated types of cancer. Treatment options for spine sarcomas are limited to chemotherapy, radiotherapy and surgical intervention. Accumulating evidence suggests a complex course associated with the treatment of spine sarcomas as compared to other soft tissue sarcomas in the extremities since adjuvant therapy adds limited success to the oncological outcome. Likewise, the limitations of surgical interventions imposed by the proximity and high sensitivity of the spinal cord, leads to an increased recurrence and mortality rates associated with spine sarcomas. Finding novel treatment options to spine sarcomas as such is inevitable, necessitating a more thorough understanding of the different mechanisms of the underlying etiologies of these tumors. In this review, we discuss the most recent studies tackling the involvement of the immune system; a key player in the emergence of the different types of spine sarcomas and the promising immune-mediated targeted therapy that can be applied in these kind of rare cancers.
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Affiliation(s)
- Charbel K Moussalem
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Elie Massaad
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Baassiri
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - M Akhtar Anwar
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Lebanon
| | - Ali Eid
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Lebanon
| | - Nadine Darwiche
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Lebanon
| | - Ibrahim Omeis
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Lebanon.
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16
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Grilley-Olson JE, Webber NP, Demos DS, Christensen JD, Kirsch DG. Multidisciplinary Management of Oligometastatic Soft Tissue Sarcoma. Am Soc Clin Oncol Educ Book 2018; 38:939-948. [PMID: 30231386 DOI: 10.1200/edbk_200573] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Soft tissue sarcomas (STS) encompass a group of rare but heterogeneous diseases. Nevertheless, many patients, particularly those with oligometastatic disease can benefit from thoughtful multimodality evaluation and treatment regardless of the STS subtype. Here, we review surgical, interventional radiology, radiation, and chemotherapy approaches to maximize disease palliation and improve survival, including occasionally long-term disease-free survival. Surgical resection can include lung or other visceral, soft tissue and bone metastases with a goal of rendering the patient disease free. Staged resections can be appropriate, and serial resection of oligometastatic recurrent disease can be appropriate. Retrospective series suggest survival benefit from this approach, although selection bias may contribute. Interventional radiology techniques such as percutaneous thermal ablation (PTA) and arterial embolization can present nonoperative local approaches in patients who are not medically fit for surgery, surgery is too morbid, or patients who decline surgery. Similarly, radiation therapy can be delivered safely to areas that are inaccessible surgically or would result in excessive morbidity. Currently no randomized trials exist comparing interventional radiologic approaches or radiation therapy to surgery but retrospective reviews show relatively similar magnitude of benefit in terms of disease palliation and survival, although it is felt unlikely that these procedures will render a patient to long-term disease-free status. Chemotherapy has evolved recently with the addition of several new treatment options, briefly reviewed here. Importantly, if a patient sustains a good response to chemotherapy resulting in true oligometastatic disease, consideration of multimodality local therapy approaches can be considered in the appropriate patient.
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Affiliation(s)
- Juneko E Grilley-Olson
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - Nicholas P Webber
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - David S Demos
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - Jared D Christensen
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - David G Kirsch
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
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17
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Farooqi A, Bishop AJ, Narang S, Allen PK, Li J, McAleer MF, Tatsui CE, Rhines LD, Amini B, Wang XA, Ghia AJ. Outcomes After Hypofractionated Dose-Escalation using a Simultaneous Integrated Boost Technique for Treatment of Spine Metastases Not Amenable to Stereotactic Radiosurgery. Pract Radiat Oncol 2018; 9:e142-e148. [PMID: 30385151 DOI: 10.1016/j.prro.2018.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/25/2018] [Accepted: 10/17/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Spine stereotactic radiosurgery delivers an ablative dose of radiation therapy (RT) with high conformity relative to standard fractionated RT. This technique is suboptimal for extended targets (>3 vertebral levels) owing to treatment alignment concerns or for patients with marked epidural extension. In these patients, we hypothesized that use of hypofractionated intensity modulated RT/volumetric modulated arc therapy to dose escalate the gross tumor volume (GTV) to 40 Gy as a spinal simultaneous integrated boost (SSIB) would allow for durable local control and palliation. METHODS AND MATERIALS We retrospectively analyzed 15 separate spinal sites (12 patients) that were treated with the SSIB technique between 2012 and 2016. The GTV and clinical target volume were prescribed at 40 Gy and 30 Gy, respectively, in 10 fractions. The spinal cord was allowed a maximum point dose of 34 Gy. The GTV was defined as gross tumor. The clinical target volume encompassed the GTV in addition to the involved vertebral bodies, at-risk paraspinal space, and spinal canal, followed by a planning target volume expansion of 3 to 5 mm. RESULTS The median follow-up for patients in our cohort was 17 months. At 1 year, local control was 93%, and overall survival was 58%, with a median time to death after treatment of 7 months. No grade ≥2 neurologic toxicities were reported for any of the patients. Nine of 12 patients had pain at presentation, of which 7 patients (78%) reported improvement and/or complete resolution of their pain after treatment. CONCLUSIONS Our early experience using a dose of 40 Gy to the GTV delivered via an SSIB technique, in lieu of spine stereotactic radiation surgery but more aggressive than conventional palliative doses, provides durable local control and pain relief. This technique may allow for improved local control and palliation in patients with radioresistant disease compared with conventional 3-dimensional conformal fractionated RT.
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Affiliation(s)
- Ahsan Farooqi
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Andrew J Bishop
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Saphal Narang
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Pamela K Allen
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Jing Li
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Mary Frances McAleer
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Claudio E Tatsui
- Department of Neurosurgery, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Laurence D Rhines
- Department of Neurosurgery, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Behrang Amini
- Department of Radiology, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Xin A Wang
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Amol J Ghia
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas.
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18
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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: 1.2] [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.
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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
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19
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Ito K, Ogawa H, Shimizuguchi T, Nihei K, Furuya T, Tanaka H, Karasawa K. Stereotactic Body Radiotherapy for Spinal Metastases: Clinical Experience in 134 Cases From a Single Japanese Institution. Technol Cancer Res Treat 2018; 17:1533033818806472. [PMID: 30355246 PMCID: PMC6202742 DOI: 10.1177/1533033818806472] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/27/2018] [Accepted: 08/20/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECT This study aimed to clarify the outcomes of stereotactic body radiotherapy for spinal metastases with a uniform dose fractionation schedule in our institution. MATERIALS AND METHODS Patients treated with spine stereotactic body radiotherapy were retrospectively reviewed. The prescribed dose was 24 Gy in 2 fractions. End points were local control, pain control, and adverse events. Local control was defined as elimination, shrinkage, or stable disease in the tumor on imaging evaluations. Pain status was measured on a scale of 0 to 10 by patients' self-reports, and pain response was defined as the time at which pain scale score decreased by 2 or more from the baseline score without increase in analgesics. In addition, various treatment- and tumor-specific factors were evaluated to determine predictive values for local and pain control. RESULTS This study included 134 lesions in 131 patients, with: lesion histopathology, lung/colorectal/thyroid/renal/breast/prostate/sarcoma/other cancer, 24/22/18/14/12/10/6/25; reirradiation stereotactic body radiotherapy, 82 (61.2%) cases; and postoperative stereotactic body radiotherapy for epidural spinal cord compression, 45 (33.6%) cases. Median follow-up after stereotactic body radiotherapy was 9 months. The 1-year local control rate was 72.3%. Seventy (79.5%) of the 88 cases with pain from spinal metastases achieved pain response. The 1-year pain progression-free rate was 61.7%. Regarding metastases from colorectal cancer, local and pain control rates at 1 year were significantly lower compared with other cancer types (local control rate, 34.1% vs 81.8%; P < .01; pain progression-free rate, 36.9% vs 69.9%; P = .02). On multivariate analysis, colorectal cancer metastases and radiation history were identified as independent predictors of lower local and pain control rates. Radiation-induced myelopathy, radiculopathy, and vertebral compression fractures were observed in 0, 2 (1.5%), and 16 (11.9%) cases, respectively. CONCLUSIONS This study showed that spine stereotactic body radiotherapy achieved good local and pain control, with a clinically acceptable safety profile. However, stereotactic body radiotherapy may be less effective against spinal metastases from colorectal cancer.
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Affiliation(s)
- Kei Ito
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hiroaki Ogawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takuya Shimizuguchi
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Keiji Nihei
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Tomohisa Furuya
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Tanaka
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Aichi, Japan
| | - Katsuyuki Karasawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
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20
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Spratt DE, Beeler WH, de Moraes FY, Rhines LD, Gemmete JJ, Chaudhary N, Shultz DB, Smith SR, Berlin A, Dahele M, Slotman BJ, Younge KC, Bilsky M, Park P, Szerlip NJ. An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report. Lancet Oncol 2017; 18:e720-e730. [PMID: 29208438 DOI: 10.1016/s1470-2045(17)30612-5] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 02/08/2023]
Abstract
Spinal metastases are becoming increasingly common because patients with metastatic disease are living longer. The close proximity of the spinal cord to the vertebral column limits many conventional therapeutic options that can otherwise be used to treat cancer. In response to this problem, an innovative multidisciplinary approach has been developed for the management of spinal metastases, leveraging the capabilities of image-guided stereotactic radiosurgery, separation surgery, vertebroplasty, and minimally invasive local ablative approaches. In this Review, we discuss the variables that should be considered during the management of these patients and review the role of each discipline and their respective management options to provide optimal care. This work is synthesised into a practical algorithm to aid clinicians in the management of patients with spinal metastasis.
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Affiliation(s)
- Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
| | - Whitney H Beeler
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Fabio Y de Moraes
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Hospital Sirio-Libanes, São Paulo, Brazil
| | - Laurence D Rhines
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph J Gemmete
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Neeraj Chaudhary
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - David B Shultz
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Alejandro Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Max Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
| | - Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
| | - Kelly C Younge
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
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An analysis of knowledge-based planning for stereotactic body radiation therapy of the spine. Pract Radiat Oncol 2017; 7:e355-e360. [DOI: 10.1016/j.prro.2017.02.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 02/16/2017] [Accepted: 02/25/2017] [Indexed: 12/31/2022]
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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: 2.3] [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.
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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
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Volume of Lytic Vertebral Body Metastatic Disease Quantified Using Computed Tomography–Based Image Segmentation Predicts Fracture Risk After Spine Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 97:75-81. [DOI: 10.1016/j.ijrobp.2016.09.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/01/2016] [Accepted: 09/20/2016] [Indexed: 11/21/2022]
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