Efficacy and safety of different fractions in stereotactic body radiotherapy for spinal metastases: A systematic review

Gong, Yining; Xu, Lingyi; Zhuang, Hongqing; Jiang, Liang; Wei, Feng; Liu, Zhongjun; Li, Yan; Yu, Miao; Ni, Kaiwen; Liu, Xiaoguang

doi:10.1002/cam4.2546

Cited by 23 publications

(20 citation statements)

References 52 publications

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“…The clinical efficacy of stereotactic body radiation therapy (SBRT) for spinal tumors has been previously reported [1][2][3][4][5][6]. Precise delivery of high doses of radiation in spinal tumors with SBRT has shown potential clinical benefits.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the setup discrepancy between 6D ExacTrac and cone beam computed tomography in spine stereotactic body radiation therapy

Park

Yea

2021

PLoS ONE

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The objective of this study was to analyze the difference in residual setup errors between 6D ExacTrac and 3D cone-beam computed tomography (CBCT) image-guided systems in spinal stereotactic body radiation therapy (SBRT). We investigated 76 patients with spinal tumors who received SBRT using Novalis Tx at our institution between January 2013 and September 2020. A Vac-lok (EZ-FIX®, Arlico Medical Company, South Korea) fixture and an assistive device, based on the region involved, were used to immobilize patients and to increase the inter-fractional setup reproducibility. The difference in the root mean square (RMS) between the 6D ExacTrac and 3D CBCT was -0.75 mm, 0.45 mm, 0.16 mm, and -0.03°; the RMS value was 1.31 mm, 1.06 mm, 0.87 mm, and 0.64°; and the standard deviation was 0.80 mm, 0.72 mm, 0.62 mm, and 0.44° for lateral, longitudinal, vertical, and yaw directions, respectively. The difference in the average RMS between ExacTrac and CBCT was <1.03 mm in the translation direction and <0.47° in the rotational direction; the results were statistically significant in the lateral, longitudinal, and vertical directions, but not in the yaw direction. Thus, it is necessary to verify the ExacTrac image according to the CBCT image.

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Section: Introductionmentioning

confidence: 99%

Evaluation of the setup discrepancy between 6D ExacTrac and cone beam computed tomography in spine stereotactic body radiation therapy

Park

Yea

2021

PLoS ONE

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“…Nevertheless, we did see the trend that patients receiving lower prescription doses (<18 Gy) experienced most of the documented LFs. Considering that doses around 24 Gy delivered in one fraction show reasonable LC rates for the initial treatment of spinal metastasis, it may decrease the chance of LF if doses of at least 19 Gy in one fraction may be applied (25). Besides, patients with a minimal dose of 13 Gy or less experienced significantly more local recurrences.…”

Section: Local Control and Survivalmentioning

confidence: 99%

Image-Guided Robotic Radiosurgery for the Treatment of Same Site Spinal Metastasis Recurrences

Ehret

Mose²,

Kufeld³

et al. 2021

Front. Oncol.

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BackgroundDue to recent medical advancements, patients suffering from metastatic spinal disease have a prolonged life expectancy than several decades ago, and some will eventually experience relapses. Data for the retreatment of spinal metastasis recurrences occurring at the very same macroscopic spot as the initially treated lesion are limited. Previous studies mainly included recurrences in the boundary areas as well as other macroscopic parts of the initially affected vertebrae. This study exclusively analyzes the efficacy and safety of spinal reirradiation for recurrences on the same site utilizing single-session robotic radiosurgery.Materials and MethodsPatients between 2005 and 2020 who received radiotherapy for a spinal metastasis suffering from a local recurrence were eligible for analysis. Only patients undergoing a single-session reirradiation were included. All recurrences must have been occurred in the same location as the initial lesion. This was defined as a macroscopic recurrence on computed tomography occurring at the same site as the initial spinal metastasis. All other lesions, including those in the boundary areas or other parts of the initially affected vertebrae, were excluded.ResultsFifty-three patients with fifty-three lesions were retreated for spinal metastases. The median dose and number of fractions for the initial radiotherapy were 36 Gy and 15, respectively. Eleven patients were initially treated with stereotactic body radiotherapy. Retreatment was performed with a median dose of 18 Gy prescribed to a median isodose of 70%. The local control was 77% after a median follow-up of 22.2 months. Patients experiencing a second recurrence received a lower dose (p = 0.04), mostly below 18 Gy, and had a worse coverage (p = 0.01) than those showing local tumor control. 51% of patients experienced an improvement in pain control after treatment delivery. Besides, four vertebral compression fractures (7% of patients) but no other adverse events higher than grade 2 were observed.ConclusionSingle-session robotic radiosurgery appears to be a safe, time-saving, and effective treatment modality for spinal metastasis recurrences occurring in the same initial location if a considerable dose and coverage can be applied. Treatment results are comparable to reirradiated metastases in the boundary areas.

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“…Cancers of various origins metastasize frequently to bone, and the spine is the most common location of bone metastases ( 1 , 2 ). To relieve pain, improve neurological function, and maintain spinal stability and local tumor control, surgical intervention is necessary for certain spinal metastases ( 1 , 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

Only Tumors Angiographically Identified as Hypervascular Exhibit Lower Intraoperative Blood Loss Upon Selective Preoperative Embolization of Spinal Metastases: Systematic Review and Meta-Analysis

et al. 2021

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BackgroundThe role of preoperative embolization (PE) in reducing intraoperative blood loss (IBL) during surgical treatment of spinal metastases remains controversial.MethodsA systematic search was conducted for retrospective studies and randomized controlled trials (RCTs) comparing the IBL between an embolization group (EG) and non-embolization group (NEG) for spinal metastases. IBL data of both groups were synthesized and analyzed for all tumor types, hypervascular tumor types, and non-hypervascular tumor types.ResultsIn total, 839 patients in 11 studies (one RCT and 10 retrospective studies) were included in the analysis. For all tumor types, the average IBL did not differ significantly between the EG and NEG in the RCT (P = 0.270), and there was no significant difference between the two groups in the retrospective studies (P = 0.05, standardized mean difference [SMD] = −0.51, 95% confidence interval [CI]: −1.03 to 0.00). For hypervascular tumors determined as such by consensus (n = 542), there was no significant difference between the two groups (P = 0.52, SMD = −0.25, 95% CI: −1.01 to 0.52). For those determined as such using angiographic evidence, the IBL was significantly lower in the EG than in the NEG group, in the RCT (P = 0.041) and in the retrospective studies (P = 0.004, SMD = −0.93, 95% CI: −1.55 to −.30). For IBL of non-hypervascular tumor types, both the retrospective study (P = 0.215) and RCT (P = 0.947) demonstrated no statistically significant differences in IBL between the groups.ConclusionsOnly tumors angiographically identified as hypervascular exhibited lower IBL upon PE in this study. Further exploration of non-invasive methods to identify the vascularity of tumors is warranted.

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Efficacy and safety of different fractions in stereotactic body radiotherapy for spinal metastases: A systematic review

Cited by 23 publications

References 52 publications

Evaluation of the setup discrepancy between 6D ExacTrac and cone beam computed tomography in spine stereotactic body radiation therapy

Evaluation of the setup discrepancy between 6D ExacTrac and cone beam computed tomography in spine stereotactic body radiation therapy

Image-Guided Robotic Radiosurgery for the Treatment of Same Site Spinal Metastasis Recurrences

Only Tumors Angiographically Identified as Hypervascular Exhibit Lower Intraoperative Blood Loss Upon Selective Preoperative Embolization of Spinal Metastases: Systematic Review and Meta-Analysis

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