Radiotherapy for Patients With Metastases to the Spinal Column: A Review of 603 Patients at Shizuoka Cancer Center Hospital

Mizumoto, Masashi; Harada, Hideyuki; Asakura, Hirofumi; Hashimoto, Takayuki; Furutani, Kazuhisa; Hashii, Haruko; Murata, Hideki; Takagi, Tatsuya; Katagiri, Hirohisa; Takahashi, Mitsuru; Nishimura, Tetsuo

doi:10.1016/j.ijrobp.2009.10.056

Cited by 98 publications

(59 citation statements)

References 26 publications

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“…13,16,17 Therefore, SRS should be considered in particular for resistant histological types, because the outcomes for spine radiosurgery are equally good, regardless of histological phenotype, when a sufficient dose is delivered.…”

Section: Discussionmentioning

confidence: 99%

“…Large retrospective analyses of spinal metastases suggest that for unfavorable histological types the rate of relapse approaches 80% within 2 years, 13,17 and the rate of failure continues to increase with longer follow-up. A small randomized trial of surgical decompression for spinal cord compression followed by conventional palliative radiation therapy reported that only 25% of patients remained ambulatory at 1 year post-treatment, and less than 10% remained ambulatory after 2 years.…”

Section: Discussionmentioning

confidence: 99%

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The impact of histology and delivered dose on local control of spinal metastases treated with stereotactic radiosurgery

Yamada

Katsoulakis

Laufer

et al. 2017

FOC

165

115

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OBJECTIVE An analysis of factors contributing to durable radiographic control of spinal metastases was undertaken, drawing from a large single-institution database in an attempt to elucidate indications and dose requirements for successful treatment. METHODS All patients treated at a single institution with stereotactic radiosurgery (SRS) of the spine as first-line therapy were assessed for local progression of the treated site, defined as radiographic enlargement of the treated tumor and/or biopsy-proven evidence of active tumor cells. All patients were followed with CT, PET, or MR imaging every 3–6 months until death. Treatment decisions were made by a multidisciplinary team of radiation oncologists, neurosurgeons, and neuroradiologists. Target volumes were defined according to the international consensus guidelines and were reviewed in a multidisciplinary conference. Image-guided techniques and intensity modulation were used for every case. The tumor's histological type, gross tumor volume (GTV), dose that covers 95% of the GTV (GTV D95), percentage of GTV covered by 95% of the prescribed dose (GTV V95), planning target volume (PTV), dose that covers 95% of the PTV (PTV D95), and percentage of PTV covered by 95% of the prescribed dose (PTV V95) were analyzed for significance in relation to local control, based on time to local progression. RESULTS A total of 811 lesions were treated in 657 patients between 2003 and 2015 at a single institution. The mean follow-up and overall survival for the entire cohort was 26.9 months (range 2–141 months). A total of 28 lesions progressed and the mean time to failure was 26 months (range 9.7–57 months). The median prescribed dose was 2400 cGy (range 1600–2600 cGy). Both GTV D95 and PTV D95 were highly significantly associated with local failure in univariate analysis, but GTV and PTV and histological type did not reach statistical significance. The median GTV D95 for the cohort equal to or above the GTV D95 1830 cGy cut point (high dose) was 2356 cGy, and it was 1709 cGy for the cohort of patients who received less than 1830 cGy (low dose). In terms of PTV D95, the median dose for those equal to or above the cut point of 1740 cGy (high dose) was 2233 cGy, versus 1644 cGy for those lesions below the PTV D95 cut point of 1740 cGy (low dose). CONCLUSIONS High-dose single-session SRS provides durable long-term control, regardless of the histological findings or tumor size. In this analysis, the only significant factors predictive of local control were related to the actual dose of radiation given. Although the target volumes were well treated with the intended dose, those lesions irradiated to higher doses (median GTV D95 2356 cGy, minimum 1830 cGy) had a significantly higher probability of durable local control than those treated with lower doses (median PTV D95 2232 cGy, minimum of 1740 cGy) (p < 0.001). Patients in the high-dose cohort had a 2% cumulative rate of local failure. Histological findings were not associated with local failure, suggesting that radioresistant histological types benefit in particular from radiosurgery. For patients with a favorable prognosis, a higher dose of SRS is important for long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The impact of histology and delivered dose on local control of spinal metastases treated with stereotactic radiosurgery

Yamada

Katsoulakis

Laufer

et al. 2017

FOC

165

115

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“…Due to an increase in the survival times of patients with malignancies, the incidence of SBM is expected to rise over the years [1,2]. The majority of symptomatic SBM are caused by breast, prostate and lung cancer (56-74%) [3][4][5] and most commonly arise from the thoracic part of the spine (51-67%) [4,6]. Patients present with pain due to destruction of bone tissue and/or neurologic complaints due to nerve root and/or spinal cord compression [7,8].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of prognostic factors predicting survival in patients with spinal bone metastases

et al. 2017

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Results After screening, 142 full-text articles were obtained, of which 22 met the eligibility criteria. A total of 43 different prognostic factors were investigated in the included studies, of which 17 were relevant to pre-treatment survival estimation. The prognostic factors most frequently associated with survival were the primary tumor and the performance status. The prognostic factors most frequently not associated with survival were age, gender, number and location of the SBM and the presence of a pathologic fracture. Conclusions Prognostication for patients with SBM should be based on an accurate primary tumor classification, combined with a performance score. The benefit of adding other prognostic factors is doubtful.

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“…Eleven potential prognostic factors were investigated [12]. Performance status was evaluated using the ECOG scale [13].…”

Section: Methodsmentioning

confidence: 99%

What Is the Value of Surgical Intervention for Sacral Metastases?

Yang

et al. 2016

PLoS ONE

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ObjectiveTo investigate the impact of surgery on local control and quality of life for patients with sacral metastases and to determine whether the complications of surgery were acceptable.MethodsCurettage for metastatic lesions of the sacrum was performed in 154 patients with obvious sacral nerve compression symptoms between July 1997 and July 2014. Potential risk factors were evaluated in univariate analysis for associations with local control; multivariate conditional logistic regression was used to identify the combined effects. Complications were recorded. The pre- and postoperative visual analogue scale of pain, Eastern Cooperative Oncology Group (ECOG) scores, and quality of life scores were collected to evaluate the impact of surgery.ResultsThe cumulative survival rates were 71.8%, 41.1%, and 22.5% and the local control rates were 95.4%, 90.9%, and 79.4% at 6, 12, and 24 months, respectively. Tumors with rapid growth, the lack of preoperative radiotherapy, and application of aortic balloon occlusion were significantly associated with good local control. There were 29 (18.8%) complications related to surgery. The mean pain scores were 7.04 preoperatively, 1.66 at 1 month postoperatively (p = 0.003), and 1.51 at 3 months postoperatively (p = 0.002). The mean ECOG scores were 2.82 preoperatively and 1.47 3 months postoperatively (p < 0.001). There were significant improvements from preoperatively to 3 months postoperatively in global health status (43.3 vs. 52.1), pain (62.0 vs. 33.2), and constipation (51.4 vs. 30.3) (p < 0.001).ConclusionsSurgery for sacral metastasis is effective to palliate pain rapidly and improve constipation and quality of life and has a low rate of complications.

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Radiotherapy for Patients With Metastases to the Spinal Column: A Review of 603 Patients at Shizuoka Cancer Center Hospital

Cited by 98 publications

References 26 publications

The impact of histology and delivered dose on local control of spinal metastases treated with stereotactic radiosurgery

The impact of histology and delivered dose on local control of spinal metastases treated with stereotactic radiosurgery

A systematic review of prognostic factors predicting survival in patients with spinal bone metastases

What Is the Value of Surgical Intervention for Sacral Metastases?

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