Amol J Ghia1, Nandita Guha-Thakurta2, Kenneth Hess3, James N Yang4, Stephen H Settle5, Hadley J Sharpe6, Jing Li4, MaryFrances McAleer4, Eric L Chang7, Claudio E Tatsui8, Paul D Brown9, Laurence D Rhines8. 1. Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas. Electronic address: ajghia@mdanderson.org. 2. Department of Radiology, MD Anderson Cancer Center, University of Texas, Houston, Texas. 3. Department of Biostatistics, MD Anderson Cancer Center, University of Texas, Houston, Texas. 4. Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas. 5. Anchorage Radiation Therapy Center, Anchorage, Alaska. 6. Southeast Radiation Oncology Group PA, Charlotte, North Carolina. 7. Department of Radiation Oncology, Norris Cancer Center, University of Southern California, Los Angeles, California. 8. Department of Neurosurgery, MD Anderson Cancer Center, University of Texas, Houston, Texas. 9. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Abstract
PURPOSE: We seek to establish the feasibility of using spine stereotactic radiosurgery (SSRS), allowing for spinal cord dose constraint relaxation, as the primary management of metastatic epidural spinal cord compression (MESCC) in inoperable patients. METHODS AND MATERIALS: Inoperable patients with thoracic MESCC and no history of radiation were enrolled on this prospective phase 1 single-institution protocol. SSRS was delivered to a histology-dependent prescription dose of 18 or 24 Gy. Incremental spinal cord constraint relaxation was performed from a Dmax cohort of 10 Gy up to 16 Gy only if tumor progression occurred and the risk of radiation-induced myelopathy (RM) remained lower than the risk of tumor progression. RESULTS: Thirty-two patients enrolled on the trial; 4, 12, 9, and 7 patients were in the 10 Gy, 12 Gy, 14 Gy, and 16 Gy cord Dmax cohorts, respectively. At baseline, there were 2 sites with MESCC grade 1A, 10 sites with grade 1B, 10 sites with grade 1C, 9 sites with grade 2, and 1 site with grade 3 disease. Among the 28 evaluable patients, the median overall survival was 28.6 months (95% confidence interval [CI], 9.2-48.0 months), and the 1-year local control was 89% (95% CI, 74%- 97%). With a median follow-up of 17 months, there were no cases of RM (upper 95% CI, 12%). In the cohort receiving a cord Dmax of 16 Gy, there were no cases of RM (upper 95% CI, 39%) with a median follow-up of 17 months (range, 12.7-21.0 months). CONCLUSIONS: SSRS is a safe and effective tool in patients with MESCC. In high-risk inoperable patients with MESCC receiving SSRS, dose constraint relaxation of the cord constraint dmax to 16 Gy may be considered to optimize local control, with the acknowledgment that this is based on 6 evaluable patients who received this dose in this trial.
PURPOSE: We seek to establish the feasibility of using spine stereotactic radiosurgery (SSRS), allowing for spinal cord dose constraint relaxation, as the primary management of metastatic epidural spinal cord compression (MESCC) in inoperable patients. METHODS AND MATERIALS: Inoperable patients with thoracic MESCC and no history of radiation were enrolled on this prospective phase 1 single-institution protocol. SSRS was delivered to a histology-dependent prescription dose of 18 or 24 Gy. Incremental spinal cord constraint relaxation was performed from a Dmax cohort of 10 Gy up to 16 Gy only if tumor progression occurred and the risk of radiation-induced myelopathy (RM) remained lower than the risk of tumor progression. RESULTS: Thirty-two patients enrolled on the trial; 4, 12, 9, and 7 patients were in the 10 Gy, 12 Gy, 14 Gy, and 16 Gy cord Dmax cohorts, respectively. At baseline, there were 2 sites with MESCC grade 1A, 10 sites with grade 1B, 10 sites with grade 1C, 9 sites with grade 2, and 1 site with grade 3 disease. Among the 28 evaluable patients, the median overall survival was 28.6 months (95% confidence interval [CI], 9.2-48.0 months), and the 1-year local control was 89% (95% CI, 74%- 97%). With a median follow-up of 17 months, there were no cases of RM (upper 95% CI, 12%). In the cohort receiving a cord Dmax of 16 Gy, there were no cases of RM (upper 95% CI, 39%) with a median follow-up of 17 months (range, 12.7-21.0 months). CONCLUSIONS: SSRS is a safe and effective tool in patients with MESCC. In high-risk inoperable patients with MESCC receiving SSRS, dose constraint relaxation of the cord constraint dmax to 16 Gy may be considered to optimize local control, with the acknowledgment that this is based on 6 evaluable patients who received this dose in this trial.
Authors: Yi-Jun Kim; Jin Ho Kim; Kyubo Kim; Hak Jae Kim; Eui Kyu Chie; Kyung Hwan Shin; Hong-Gyun Wu; Il Han Kim Journal: Cancer Res Treat Date: 2019-01-29 Impact factor: 4.679
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
Authors: Ricardo Llorente; Benjamin O Spieler; James Victoria; Cristiane Takita; Raphael Yechieli; John C Ford; Karen Brown; Michael A Samuels; Eric A Mellon Journal: Br J Radiol Date: 2019-11-12 Impact factor: 3.039