Incidence and Time of Onset of Osseous Pseudoprogression in Patients With Metastatic Spine Disease From Renal Cell or Prostate Carcinoma After Treatment With Stereotactic Body Radiation Therapy

Maralani, Pejman Jabehdar; Winger, Kathleen Tina; Symons, Sean; Machnowska, Matylda; Heyn, Chinthaka; Helmi, Ali; Chan, Alex Siu Wing; Tseng, Chia‐Lin; Sahgal, Arjun

doi:10.1093/neuros/nyy075

Cited by 19 publications

(7 citation statements)

References 18 publications

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“…Rather than true progression which demonstrates consistent growth over time, the radiographical appearance of pseudoprogression subsequently subsides on serial imaging. The incidence of pseudoprogression has been reported in the range of 14–37% and risk factors include lytic tumors, earlier volume enlargement, greater GTV to reference non-irradiated vertebral body T2 intensity ratio, and growth confined to 80% of the prescription isodose line (67–69).…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiotherapy (SBRT) for Oligometastatic Spine Metastases: An Overview

et al. 2019

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The oligometastatic state is hypothesized to represent an intermediary state of cancer between widely metastatic disease and curable, localized disease. Advancements in radiotherapy have allowed for delivery of high precision, dose escalated treatment known as stereotactic body radiotherapy (SBRT) to targets throughout the body with excellent rates of local control. Recently, the first phase II randomized trial comparing conventional radiotherapy to comprehensive SBRT of oligometastatic disease demonstrated an overall survival and progression free survival advantage. The spine is a common site of metastasis, and a complex site for SBRT given the adjacent spinal cord and the tumor embedded within the bone tissue putting the patient at risk of fracture. Although there are expert spine SBRT guidelines for practice, there are as yet no reported randomized trials that proves superiority as compared to conventional radiation. The use of SBRT in patients with oligometastatic disease and spinal metastases is the focus of this review.

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Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiotherapy (SBRT) for Oligometastatic Spine Metastases: An Overview

et al. 2019

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“…Where reported, LC was usually defined as an absence of tumor volume change consistent with radiologic progression. As the radiotherapy community is gaining more experience with SBRT, it becomes clear that pseudoprogression and tissue necrosis are important factors to consider after SBRT (58, 87). Only four studies accounted for pseudoprogression by obtaining confirmatory scans before the lesion was classified as progressing, potentially resulting in an underestimation of LC.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of the Role of Stereotactic Radiotherapy for Bone Metastases

Spencer¹,

Velden²,

Wong³

et al. 2019

JNCI: Journal of the National Cancer Institute

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Background Stereotactic radiotherapy (SBRT) might improve pain and local control in patients with bone metastases compared to conventional radiotherapy, although an overall estimate of these outcomes is currently unknown. Methods A systematic review was carried out following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pubmed, Embase, and Cochrane databases were systematically searched to identify studies reporting pain response and local control among patients with bone metastases from solid-organ tumors who underwent SBRT in 1–6 fractions. All studies prior to April 15, 2017, were included. Study quality was assessed by predefined criteria, and pain response and local control rates were extracted. Results A total of 2619 studies were screened; 57 were included (reporting outcomes for 3995 patients) of which 38 reported pain response and 45 local control rates. Local control rates were high with pain response rates above those previously reported for conventional radiotherapy. Marked heterogeneity in study populations and delivered treatments were identified such that quantitative synthesis was not appropriate. Reported toxicity was limited. Of the pain response studies, 73.7% used a retrospective cohort design and only 10.5% used the international consensus endpoint definitions of pain response. The median survival within the included studies ranged from 8 to 30.4 months, suggesting a high risk of selection bias in the included observational studies. Conclusions This review demonstrates the potential benefit of SBRT over conventional palliative radiotherapy in improving pain due to bone metastases. Given the methodological limitations of the published literature, however, large randomized trials are now urgently required to better quantify this benefit.

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“…It is worth noting that the use of the 80% isodose line to describe the high dose region was extrapolated from the CNS setting and has not been validated for the spine. Maralani et al retrospectively reviewed 43 spinal segments treated with SABR 31 . Sixteen (16) arose from prostate cancer (i.e.…”

Section: Resultsmentioning

confidence: 99%

Imaging response assessment following stereotactic body radiotherapy for solid tumour metastases of the spine: Current challenges and future directions

O'Sullivan

McDermott

Keys³

et al. 2020

J Med Imag Rad Onc

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Patients with metastatic disease are routinely serially imaged to assess disease burden and response to systemic and local therapies, which places ever‐expanding demands on our healthcare resources. Image interpretation following stereotactic body radiotherapy (SBRT) for spine metastases can be challenging; however, appropriate and accurate assessment is critical to ensure patients are managed correctly and resources are optimised. Here, we take a critical review of the merits and pitfalls of various imaging modalities, current response assessment guidelines, and explore novel imaging approaches and the potential for radiomics to add value in imaging assessment.

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Incidence and Time of Onset of Osseous Pseudoprogression in Patients With Metastatic Spine Disease From Renal Cell or Prostate Carcinoma After Treatment With Stereotactic Body Radiation Therapy

Abstract: There was a higher incidence of PP in lytic compared to sclerotic primary tumor type. PP in spinal metastatic sites may have variable presentations depending on the primary cancer.

Cited by 19 publications

References 18 publications

Stereotactic Body Radiotherapy (SBRT) for Oligometastatic Spine Metastases: An Overview

Stereotactic Body Radiotherapy (SBRT) for Oligometastatic Spine Metastases: An Overview

Systematic Review of the Role of Stereotactic Radiotherapy for Bone Metastases

Imaging response assessment following stereotactic body radiotherapy for solid tumour metastases of the spine: Current challenges and future directions

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