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Kotecha R, Schiro B, Sporrer J, Rubens M, Avendano M, Appel H, Tom M, Mehta M. SPIN-01 RADIATION THERAPY ALONE VERSUS RADIATION THERAPY PLUS RADIOFREQUENCY ABLATION/VERTEBRAL AUGMENTATION FOR SPINE METASTASIS: TRIAL IN PROGRESS. Neurooncol Adv 2022. [PMCID: PMC9354164 DOI: 10.1093/noajnl/vdac078.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Spine metastases are a common occurrence in cancer patients and result in pain, neurologic deficits, decline in performance status, disability, inferior quality of life (QOL), and reduction in ability to receive cancer-directed therapies. Conventional external beam radiation therapy (EBRT) is associated with modest rates of pain relief, high rates of disease recurrence, low response rates for those with radioresistant histologies, and limited improvement in neurologic deficits. The addition of radiofrequency ablation/percutaneous vertebral augmentation (RFA/PVA) to index sites together with EBRT may improve pain response rates and corresponding quality of life. METHODS/DESIGN This is a single-center, prospective, randomized, controlled trial in patients with spine metastases from T5-L5, stratified according to tumor type (radioresistant vs. radiosensitive) in which patients in each stratum are randomized in a 2:1 ratio to either RFA/PVA and EBRT or EBRT alone. All patients are treated with EBRT to a dose of 20-30 Gy in 5-10 fractions. The target parameters are measured and recorded at the baseline clinic visit, and daily at home with collection of weekly measurements at 1, 2, and 3 weeks after treatment, and at 3, 6, 12, and 24 months following treatment with imaging and QOL assessments. DISCUSSION The primary objective of this randomized trial is to determine whether RFA/PVA in addition to EBRT improves pain control compared to palliative EBRT alone for patients with spine metastases, defined as complete or partial pain relief (measured using the Numerical Rating Pain Scale [NRPS]) at 3 months. Secondary objectives include determining whether combined modality treatment improves the rapidity of pain response, duration of pain response, patient reported pain impact, health utility, and overall QOL. The results from this study will be used to allow for comparisons to alternative treatment approaches. This trial was activated 5/2020 and is open to accrual.
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Affiliation(s)
| | - Brian Schiro
- Miami Cardiac & Vascular Institute , Miami, FL , USA
| | | | | | | | | | - Martin Tom
- Miami Cancer Institute , Miami, FL , USA
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Kotecha R, Schiro BJ, Sporrer J, Rubens M, Appel HR, Calienes KS, Boulanger B, Pujol MV, Suarez DT, Pena A, Kudryashev A, Mehta MP. Radiation therapy alone versus radiation therapy plus radiofrequency ablation/vertebral augmentation for spine metastasis: study protocol for a randomized controlled trial. Trials 2020; 21:964. [PMID: 33228756 PMCID: PMC7685662 DOI: 10.1186/s13063-020-04895-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022] Open
Abstract
Background Spine metastasis is a common occurrence in cancer patients and results in pain, neurologic deficits, decline in performance status, disability, inferior quality of life (QOL), and reduction in ability to receive cancer-directed therapies. Conventional external beam radiation therapy (EBRT) is associated with modest rates of pain relief, high rates of disease recurrence, low response rates for those with radioresistant histologies, and limited improvement in neurologic deficits. The addition of radiofrequency ablation/percutaneous vertebral augmentation (RFA/PVA) to index sites together with EBRT may improve pain response rates and corresponding quality of life. Methods/design This is a single-center, prospective, randomized, controlled trial in patients with spine metastasis from T5-L5, stratified according to tumor type (radioresistant vs. radiosensitive) in which patients in each stratum will be randomized in a 2:1 ratio to either RFA/PVA and EBRT or EBRT alone. All patients will be treated with EBRT to a dose of 20–30 Gy in 5–10 fractions. The target parameters will be measured and recorded at the baseline clinic visit, and daily at home with collection of weekly measurements at 1, 2, and 3 weeks after treatment, and at 3, 6, 12, and 24 months following treatment with imaging and QOL assessments. Discussion The primary objective of this randomized trial is to determine whether RFA/PVA in addition to EBRT improves pain control compared to palliative EBRT alone for patients with spine metastasis, defined as complete or partial pain relief (measured using the Numerical Rating Pain Scale [NRPS]) at 3 months. Secondary objectives include determining whether combined modality treatment improves the rapidity of pain response, duration of pain response, patient reported pain impact, health utility, and overall QOL. Trial registration ClinicalTrials.gov NCT04375891. Registered on 5 May 2020.
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Affiliation(s)
- Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Office 1R203, Miami, FL, 33176, USA. .,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
| | - Brian J Schiro
- Vascular and Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Justin Sporrer
- Neuroscience Center, Baptist Health South Florida, Miami, FL, USA
| | - Muni Rubens
- Office of Clinical Research, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Haley R Appel
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Office 1R203, Miami, FL, 33176, USA
| | - Kathleen S Calienes
- Office of Clinical Research, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Belinda Boulanger
- Office of Clinical Research, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Marietsy V Pujol
- Office of Clinical Research, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Deborah T Suarez
- Office of Clinical Research, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Ashley Pena
- Office of Clinical Research, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Alex Kudryashev
- Office of Clinical Research, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Office 1R203, Miami, FL, 33176, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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Abstract
OBJECTIVE To identify risk factors for death and respiratory failure in persons with penicillin-sensitive pneumococcal bacteremia and pneumonia from data available at initial clinical evaluation. DESIGN Retrospective chart review of persons with pneumococcal bacteremia and pneumonia. SETTING Tertiary care medical center (University of California Davis Medical Center, Sacramento). PATIENTS One hundred two consecutive adults admitted to the hospital for treatment of pneumococcal pneumonia with bacteremia. RESULTS Of 102 persons, 25 (25%; 95% confidence interval [CI], 17 to 34%) died and 17 (16%; 95% CI, 10 to 25%) survived mechanical ventilation for respiratory failure. In univariate analyses, persons with preexisting lung disease (relative risk [RR], 2.0; 95% CI, 1.3 to 3.1), initial body temperature < 38 degrees C (RR, 2.1; 95% CI, 1.3 to 3.6), or nosocomial infections (RR, 2.5; 95% CI, 1.8 to 3.6) or who were > or = 48 years old (RR, 2.7; 95% CI, 1.5 to 4.8) were at greater risk for adverse outcomes than persons without these risk factors. Of 25 persons without these risk factors, only one (4%; 95% CI, 0 to 20%) died, and the remaining 24 persons did not require intensive care. Using these risk factors in a multivariate logistic model, death or respiratory failure would have been predicted in 67% of persons and better outcome predicted in 83% of the persons. In multivariate analysis, nosocomial infection was the greatest risk factor (adjusted odds ratio, 17.3; 95% CI, 3.1 to 98). CONCLUSIONS Risk factors identified at hospital admission can predict the outcome in persons with pneumococcal pneumonia and bacteremia. Identifying these factors may allow earlier use of intensive care or more aggressive treatment. Independent of age, nosocomially acquired infections were the greatest risk factor for death or respiratory failure.
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Affiliation(s)
- A A Marfin
- Division of Respiratory Disease Studies, National Institute for Occupational and Safety and Health, Centers for Disease Control and Prevention, Morgantown, WVa
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