Randa Tao1, Andrew J Bishop1, Zachary Brownlee1, Pamela K Allen1, Stephen H Settle1, Eric L Chang2, Xin Wang1, Behrang Amini3, Nizar M Tannir4, Claudio Tatsui5, Laurence D Rhines5, Paul D Brown1, Amol J Ghia6. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 2. Department of Radiation Oncology, USC Norris Cancer Hospital, Keck School of Medicine of USC, Los Angeles, California. 3. Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 4. Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 5. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. 6. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: ajghia@mdanderson.org.
Abstract
PURPOSE: To evaluate the outcomes in patients treated on prospective phase 1-2 protocols with postoperative stereotactic body radiation therapy (SBRT) and identify the associated prognostic variables. METHODS AND MATERIALS: Sixty-six patients with 69 tumors were treated with SBRT on prospective phase 1-2 studies for spinal metastases between 2002 and 2010. All patients underwent SBRT after spine surgery, which included laminectomy, vertebrectomy, or a combination of these techniques. Renal cell carcinoma was the most common histology represented (n=35, 53%) followed by sarcomas (n=13, 20%). Thirty-one patients (47%) were treated with prior conventional radiation to the spine (median dose 30 Gy). Patients were followed up with spinal magnetic resonance imaging (MRI) studies to determine the treated tumor control (TC). Pain and other symptom data were collected prospectively to determine treatment response and toxicity. RESULTS: The median follow-up time was 30 months (range, 1-145 months) for all patients and 75 months for living patients (range, 6-145 months). The actuarial 1-year rate of TC was 85%, adjacent vertebral body control was 85%, and overall survival (OS) was 74% (median 29 months). On multivariate competing-risks analysis, sarcoma histology (subhazard ratio [SHR] = 2.38, 95% confidence interval [CI] 1.05-5.6, P=.04) and larger preoperative tumor volumes (SHR=1.01, 95% CI 1.0-1.01, P=.006) were significantly associated with worse TC. Karnofsky performance status was the only significant predictor for OS on multivariate analysis. There were no differences in TC between patients treated with different surgical techniques or different preoperative or postoperative Bilsky grades. There were no grade 3 or higher neurologic toxicities. CONCLUSION: This study represents a large series of prospective data available on patients treated with SBRT in the postoperative setting. The combination of surgery with SBRT can offer patients with metastatic disease to the spine the chance of durable tumor control with minimal toxicity.
PURPOSE: To evaluate the outcomes in patients treated on prospective phase 1-2 protocols with postoperative stereotactic body radiation therapy (SBRT) and identify the associated prognostic variables. METHODS AND MATERIALS: Sixty-six patients with 69 tumors were treated with SBRT on prospective phase 1-2 studies for spinal metastases between 2002 and 2010. All patients underwent SBRT after spine surgery, which included laminectomy, vertebrectomy, or a combination of these techniques. Renal cell carcinoma was the most common histology represented (n=35, 53%) followed by sarcomas (n=13, 20%). Thirty-one patients (47%) were treated with prior conventional radiation to the spine (median dose 30 Gy). Patients were followed up with spinal magnetic resonance imaging (MRI) studies to determine the treated tumor control (TC). Pain and other symptom data were collected prospectively to determine treatment response and toxicity. RESULTS: The median follow-up time was 30 months (range, 1-145 months) for all patients and 75 months for living patients (range, 6-145 months). The actuarial 1-year rate of TC was 85%, adjacent vertebral body control was 85%, and overall survival (OS) was 74% (median 29 months). On multivariate competing-risks analysis, sarcoma histology (subhazard ratio [SHR] = 2.38, 95% confidence interval [CI] 1.05-5.6, P=.04) and larger preoperative tumor volumes (SHR=1.01, 95% CI 1.0-1.01, P=.006) were significantly associated with worse TC. Karnofsky performance status was the only significant predictor for OS on multivariate analysis. There were no differences in TC between patients treated with different surgical techniques or different preoperative or postoperative Bilsky grades. There were no grade 3 or higher neurologic toxicities. CONCLUSION: This study represents a large series of prospective data available on patients treated with SBRT in the postoperative setting. The combination of surgery with SBRT can offer patients with metastatic disease to the spine the chance of durable tumor control with minimal toxicity.
Authors: Roman O Kowalchuk; Michael R Waters; K Martin Richardson; Kelly Spencer; James M Larner; Jason P Sheehan; William H McAllister; Charles R Kersh Journal: J Radiosurg SBRT Date: 2020
Authors: Ori Barzilai; Ilya Laufer; Adam Robin; Ran Xu; Yoshiya Yamada; Mark H Bilsky Journal: Oper Neurosurg (Hagerstown) Date: 2019-03-01 Impact factor: 2.703
Authors: Amol J Ghia; Nandita Guha-Thakurta; Juhee Song; Peter Thall; Tina M Briere; Stephen H Settle; Hadley J Sharp; Jing Li; MaryFrances McAleer; Eric L Chang; Claudio E Tatsui; Paul D Brown; Laurence D Rhines Journal: N Am Spine Soc J Date: 2021-05-01