Radiation Therapy of Spinal Metastases: Results with Different Fractionations

Tombolini, Vincenzo; Zurlo, Alfredo; Montagna, A.; Notarianni, E.; Mf, Osti; Rm, Enrici; Pirolli, C

doi:10.1177/030089169408000508

Cited by 15 publications

(7 citation statements)

References 9 publications

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“…In 1 study, Tombolini et al 6 treated 103 spinal sites from 95 patients with either a single fraction of 8 Gy, hypofractionation regimens of 20 Gy in 4-5 days, or conventional fractionation regimens to 30-40 Gy in 2-4 weeks. No differences between fractionation schemes were seen, with pain responses varying from 80% to 85%.…”

mentioning

confidence: 99%

Cyberknife radiosurgery for breast cancer spine metastases

Gagnon¹,

Henderson²,

Gehan³

et al. 2007

Cancer

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BACKGROUND.There are few options for breast cancer patients with spinal metastases recurrent within a previous radiation treatment field. CyberKnife radiosurgery has been used in our institution to treat such patients. To evaluate their outcomes, as there are no comparable radiation treatment options, the outcomes were compared between 18 patients with spinal metastases from breast cancer treated with CyberKnife stereotactic radiosurgery, 17 of which had prior radiotherapy to the involved spinal region and were progressing, and 18 matched patients who received conventional external beam radiotherapy (CRT) up‐front for spinal metastases.METHODS.Radiosurgery was delivered in 3 to 5 fractions to doses ranging from 2100 to 2800 cGy. Women were matched to patients in a CRT group with respect to time from original diagnosis to diagnosis of metastases, estrogen receptor / progesterone receptor (ER/PR) status, presence or absence of visceral metastases, prior radiotherapy, and prior chemotherapy. Survival and complications were compared between treatment groups. Surviving patients were followed out to 24 months.RESULTS.The CyberKnife and CRT groups were comparable along all matching dimensions and in performance status before treatment. Outcomes of treatment were similar for patients in both groups; ambulation, performance status, and pain worsened similarly across groups posttreatment. Survival and the number of complications appeared to favor the CyberKnife group, but the differences did not reach statistical significance.CONCLUSIONS.The statistical comparability of the CyberKnife and CRT groups reflects the small sample size and stringent requirements for significance of the matched‐pair analysis. Nevertheless, comparability in these difficult cases shows that salvage CyberKnife treatment is as efficacious as initial CRT without added toxicity. Cancer 2007. © 2007 American Cancer Society.

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confidence: 99%

Cyberknife radiosurgery for breast cancer spine metastases

Gagnon¹,

Henderson²,

Gehan³

et al. 2007

Cancer

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“…Early attempts at hypofractionation were hindered by the inability to precisely deliver radiation, making the spinal cord the dose limiting structure. Consequently, hypofractionation trials could only utilize a moderate dose, and 8 Gy in a single fraction (1 × 8 Gy) to spinal metastases did not show significant differences from CFRT [15].…”

Section: Stereotactic Body Radiotherapymentioning

confidence: 98%

Role of stereotactic body radiotherapy in spinal metastasis and subsequent fracture risk: identifying and treating the at-risk patient

Anwar

Barani

2013

CNS Oncol.

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The treatment of spinal metastasis has considerably improved with the advent of stereotactic body radiotherapy. Technological advances have enabled the precise delivery of high-dose radiation that may supplant surgery and standard fractionation postoperative radiation as a treatment for spinal metastasis without cord compression. Unfortunately, the higher biologically equivalent doses conferred by stereotactic body radiotherapy can also result in radiation toxicity, notably myelitis and vertebral body fracture. These are toxicities that the radiation oncologist must be able to anticipate, mitigate and manage. Although myelitis can be prevented largely by instituting dose constraints, it is less clear what the fracture risk of a structurally compromised vertebra is, and what should be done in terms of stabilization and dosimetry to mitigate this risk. This review answers these questions by defining the appropriate patient for stereotactic body radiotherapy, and what dose, fractionation and spinal stabilization should be used for potentially unstable spines.

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“…Over 100,000 bone metastases are identified in North America each year and of those an estimated 30-40,000 cases of metastatic breast cancer lesions occur in the spine. 1,2 Yet, despite this alarming statistic, the frontline approach for treating such cancers remains irrefutably unsatisfactory and the related diagnosis is often met with a poor prognosis. Presently, radiation therapy ͑RT͒ is considered the mainstay of treatment for ambulatory patients, whereas surgery is reserved for those experiencing collapse or neurological compromise.…”

Section: Introductionmentioning

confidence: 99%

Photodynamic therapy for the treatment of metastatic lesions in bone: Studies in rat and porcine models

et al. 2005

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This study represents the first reported use of photodynamic therapy (PDT) for metastatic bone lesions and specifically, as a treatment for spinal metastases. A model of bone metastasis in rat confirmed the efficacy of benzoporphyrin derivative-monoacid-mediated PDT for treating lesions within the spine and appendicular bone. Fluorimetry confirmed the selective accumulation of drug into the tumor(s) at 3 h post-injection. 48 h post-light delivery into the vertebral body of the rat spine loss of bioluminescent signal and histological analyses of sectioned spine confirmed MT-1 tumor cell kill in vivo as previously confirmed in vitro using an established cell viability assay. Porcine vertebrae provided a model comparable to that of human for light propagation and PDT response. Histological examination of vertebrae 48 h post-PDT revealed a necrotic radius of 0.6 cm with an average fluence rate of 4.3 mW/cm2. Non-necrotic tissue damage was evident up to 2 cm out from the treatment fiber. Results support the application of PDT to the treatment of primary or metastatic lesions within bone.

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Radiation Therapy of Spinal Metastases: Results with Different Fractionations

Cited by 15 publications

References 9 publications

Cyberknife radiosurgery for breast cancer spine metastases

Cyberknife radiosurgery for breast cancer spine metastases

Role of stereotactic body radiotherapy in spinal metastasis and subsequent fracture risk: identifying and treating the at-risk patient

Photodynamic therapy for the treatment of metastatic lesions in bone: Studies in rat and porcine models

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