PURPOSE: To evaluate the outcomes after dose-escalated radiotherapy (RT) for spinal metastases and paraspinal tumors. METHODS AND MATERIALS: A total of 14 patients, 12 with spinal metastases and a long life expectancy and 2 with paraspinal tumors, were treated for 16 lesions with intensity-modulated, image-guided RT. A median biologic effective dose of 74 Gy(10) (range, 55-86) in a median of 20 fractions (range, 3-34) was prescribed to the target volume. The spinal canal was treated to 40 Gy in 20 fractions using a second intensity-modulated RT dose level in the case of epidural involvement. RESULTS: After median follow-up of 17 months, one local recurrence was observed, for an actuarial local control rate of 88% after 2 years. Local control was associated with rapid and long-term pain relief. Of 11 patients treated for a solitary spinal metastasis, 6 developed systemic disease progression. The actuarial overall survival rate for metastatic patients was 85% and 63% after 1 and 2 years, respectively. Acute Grade 2-3 skin toxicity was seen in 2 patients with no late toxicity greater than Grade 2. No radiation-induced myelopathy was observed. CONCLUSION: Dose-escalated irradiation of spinal metastases was safe and resulted in excellent local control. Oligometastatic patients with a long life expectancy and epidural involvement are considered to benefit the most from fractionated RT.
PURPOSE: To evaluate the outcomes after dose-escalated radiotherapy (RT) for spinal metastases and paraspinal tumors. METHODS AND MATERIALS: A total of 14 patients, 12 with spinal metastases and a long life expectancy and 2 with paraspinal tumors, were treated for 16 lesions with intensity-modulated, image-guided RT. A median biologic effective dose of 74 Gy(10) (range, 55-86) in a median of 20 fractions (range, 3-34) was prescribed to the target volume. The spinal canal was treated to 40 Gy in 20 fractions using a second intensity-modulated RT dose level in the case of epidural involvement. RESULTS: After median follow-up of 17 months, one local recurrence was observed, for an actuarial local control rate of 88% after 2 years. Local control was associated with rapid and long-term pain relief. Of 11 patients treated for a solitary spinal metastasis, 6 developed systemic disease progression. The actuarial overall survival rate for metastatic patients was 85% and 63% after 1 and 2 years, respectively. Acute Grade 2-3 skin toxicity was seen in 2 patients with no late toxicity greater than Grade 2. No radiation-induced myelopathy was observed. CONCLUSION: Dose-escalated irradiation of spinal metastases was safe and resulted in excellent local control. Oligometastatic patients with a long life expectancy and epidural involvement are considered to benefit the most from fractionated RT.
Authors: G Z Gong; Y Yin; L G Xing; Y J Guo; T Liu; J Chen; J Lu; C Ma; T Sun; T Bai; G Zhang; R Wang Journal: Strahlenther Onkol Date: 2012-02-08 Impact factor: 3.621
Authors: Frederick Mantel; Stefan Glatz; André Toussaint; Michael Flentje; Matthias Guckenberger Journal: Strahlenther Onkol Date: 2014-06-27 Impact factor: 3.621
Authors: Matthias Guckenberger; Reinhart A Sweeney; John C Flickinger; Peter C Gerszten; Ronald Kersh; Jason Sheehan; Arjun Sahgal Journal: Radiat Oncol Date: 2011-12-15 Impact factor: 3.481
Authors: Matthias Guckenberger; Frederick Mantel; Peter C Gerszten; John C Flickinger; Arjun Sahgal; Daniel Létourneau; Inga S Grills; Maha Jawad; Daniel K Fahim; John H Shin; Brian Winey; Jason Sheehan; Ron Kersh Journal: Radiat Oncol Date: 2014-10-16 Impact factor: 3.481