Re-irradiation of Vertebral Body Metastases: Treatment in the Radiosurgery Era

Myrehaug, Sten; Soliman, Hany; Tseng, Chia‐Lin; Heyn, Chris; Sahgal, Arjun

doi:10.1016/j.clon.2017.11.005

Cited by 22 publications

(25 citation statements)

References 36 publications

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“…Nevertheless, data from the literature suggest that hyperfractionation should be considered for locally recurrent rectal cancer [ 18 - 19 ] and possibly also nasopharyngeal cancer [ 20 - 21 ]. Besides fractionation, highly conformal techniques, including brachytherapy, or in some cases proton beam irradiation may be able to reduce the volume of normal tissues exposed to high cumulative total doses [ 5 , 9 , 22 - 24 ]. As illustrated in Case three, the common policy of avoiding elective nodal irradiation in the re-irradiation setting sometimes results in relapses in adjacent nodes, which might be the source of new problems with overlapping target volumes and isodoses.…”

Section: Discussionmentioning

confidence: 99%

Second Re-irradiation: Clinical Examples of Worthwhile Treatment

Nieder

Yobuta

Mannsåker

2018

Cureus

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Introduction: Improved treatment approaches have resulted in longer survival of patients with certain types of incurable cancer, without eliminating the need for symptom palliation and supportive measures. In this context, re-irradiation is an increasingly important option. Little data exists about a second or repeat re-irradiation.Methods: From a single institution database, patients who received a second re-irradiation with cumulative equivalent doses (equivalent dose in 2-Gy fractions (EQD2) for late effects, alpha/beta-value 3 Gy) of more than 90 Gy and survived for more than six months were identified. Illustrative clinical examples were provided.Results: The examples describe the treatment of sacral bone metastases, recurrent rectal cancer, and pelvic lymph node metastases. The maximum cumulative EQD2 was 142 Gy. Symptomatic responses were obtained without clinically relevant side effects.Conclusion: These three cases illustrate that a second re-irradiation has the potential to provide worthwhile palliative effects without causing overt late toxicity during the remaining life time. In patients who tolerated previous radiotherapy well, further re-irradiation may contribute to the ever-increasing armamentarium of options that increase the survival of patients with incurable cancer and try to prolong the time period where independent living is possible.

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Section: Discussionmentioning

confidence: 99%

Second Re-irradiation: Clinical Examples of Worthwhile Treatment

Nieder

Yobuta

Mannsåker

2018

Cureus

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“…This is one of the largest reports exclusively analyzing patients treated with single-session RRS for their spinal metastasis recurrence (12)(13)(14). Only recurrences which occurred at the very same spot as the initial macroscopic metastatic lesion were included.…”

Section: Discussionmentioning

confidence: 99%

“…These should respect the previous irradiation and associated risks for myelopathies and vertebral compression fractures (VCFs) (12). Reirradiation for spinal metastases seems feasible and effective, but the number of reports is still limited (12)(13)(14)(15). Finally, data on the efficacy and safety of reirradiation with single-session robotic radiosurgery (RRS) are particularly limited (12,14).…”

Section: Introductionmentioning

confidence: 99%

“…Reirradiation for spinal metastases seems feasible and effective, but the number of reports is still limited (12)(13)(14)(15). Finally, data on the efficacy and safety of reirradiation with single-session robotic radiosurgery (RRS) are particularly limited (12,14). Besides, previous reports often included spinal recurrences in the boundary area or previously irradiated field and other parts of the initially affected vertebrae, and not just same site relapses (16,17).…”

Section: Introductionmentioning

confidence: 99%

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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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“…However, sometimes cEBRT is not effective. Several large international trials, with randomization of patients to various low-dose cEBRT regimens, have consistently reported that ~20% of patients will need reirradiation within 3–6 months for failed efficacy of the initial radiation treatment [ 7 ]. In addition, sometimes, spinal metastasis develops within the irradiation field of the previous definitive radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

Outcomes after reirradiation of spinal metastasis with stereotactic body radiation therapy (SBRT): a retrospective single institutional study

Sasamura

Suzuki

Kozuka

et al. 2020

Journal of Radiation Research

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This study was aimed at assessing the feasibility and toxicity of using stereotactic body radiation therapy (SBRT) for reirradiation of spinal metastatic tumors. We conducted a retrospective review, from our institutional database, of the data of patients who received reirradiation, with overlap of some prescribed isodose lines to the vertebra from the initial radiation therapy, between 2007 and 2019. We identified 40 patients with spinal metastatic tumors, of whom 2 had 2 metastatic vertebral lesions each, totaling up to 42 target lesions. The median dose to spinal cord at the initial radiation therapy was 30 Gy. SBRT based on the intensity-modulated radiation therapy (IMRT) technique was used for reirradiation to spare the spinal cord. All patients received a prescription dose of 25 Gy in 5 fractions to the planning target volume (PTV). Among the 40 cases who had pain, pain relief was obtained in 24 (60%) after reirradiation. Neurologic improvement was obtained in 8 of 15 cases (53%). The adverse events were evaluated using the Common Terminology Criteria for Adverse Events Version 5.0. Reirradiation was well-tolerated, with only 2 patients experiencing adverse events ≥grade 2 in severity, including 1 patient with grade 3 pain, and another patient with grade 3 spinal fracture. None of the patients developed radiation myelopathy. Our data demonstrated that reirradiation of spinal metastasis using SBRT provided effective pain relief and neurologic improvement, with minimal toxicity.

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Re-irradiation of Vertebral Body Metastases: Treatment in the Radiosurgery Era

Cited by 22 publications

References 36 publications

Second Re-irradiation: Clinical Examples of Worthwhile Treatment

Second Re-irradiation: Clinical Examples of Worthwhile Treatment

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

Outcomes after reirradiation of spinal metastasis with stereotactic body radiation therapy (SBRT): a retrospective single institutional study

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