Reirradiation of spinal metastases with intensity-modulated radiation therapy: an analysis of 23 patients

Abstract

This study aimed to evaluate the efficacy and safety of reirradiation with intensity-modulated radiation therapy (IMRT) for spinal metastases. We retrospectively analyzed 23 patients with spinal metastases who underwent IMRT reirradiation between December 2006 and July 2013. We evaluated the spinal radiation doses during the first and second radiation therapy courses, the interval between the courses, and the clinical outcomes after reirradiation, including skeletal-related events, local control rates (LCRs), overall survival (OS), and toxicities. The median time from the first irradiation to reirradiation was 13 months (range, 2–75 months). The median reirradiation dose delivered to 90% of the planning target volume was 24.5 Gy in 5 fractions (range, 14.7–50 Gy in 3–25 fractions). Nineteen patients experienced pain at reirradiation, and 15 of these attained pain relief. Two of the three patients with paresis in the upper or lower extremities upon initiation of reirradiation demonstrated improvement. Local progression was identified in four patients. The median time to local progression was 37 months. The 1- and 2-year LCRs after reirradiation were 88% and 75%, respectively. The 1- and 2-year OS rates after reirradiation were 45% and 20%, respectively, with a median OS of 12 months. No late toxicities occurred. In conclusion, spinal metastasis reirradiation using IMRT appears safe; pain relief and paresis improvement and/or prevention can be expected, along with a reduced risk of radiation-induced toxicity, especially in the spinal cord.

Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution

“…High-quality pain response data unfortunately is limited within the literature in this population of patients; however, published series suggest overall response rates of 65% to 79%. 61 – 64 …”

Clinical outcome of patients treated with re-irradiation for spine or pelvic bone metastasis: A multi-institutional analysis of 98 patients

“…This distinction may be useful in the irradiation of spine or pelvic bone metastases, particularly for Re-RT. Kawashiro et al ( 11 ) reported clinical IMRT results of Re-RT for spinal metastasis. They concluded that spinal metastasis Re-RT using IMRT was safe and that pain relief and paresis improvement and/or prevention may be expected along with a reduced risk of radiation-induced toxicity, especially in the spinal cord ( 11 ).…”

“…Kawashiro et al ( 11 ) reported clinical IMRT results of Re-RT for spinal metastasis. They concluded that spinal metastasis Re-RT using IMRT was safe and that pain relief and paresis improvement and/or prevention may be expected along with a reduced risk of radiation-induced toxicity, especially in the spinal cord ( 11 ). In addition, Jereczek-Fossa et al ( 12 ) reported that the low toxicity of Re-RT with IMRT or SBRT should allow for delivery of higher doses and lead to improvement in Re-RT outcomes.…”

Precision Stereotactic Radiotherapy for Spinal Tumors: Mechanism, Efficacy, and Issues

“…Therefore, SABR is the only option for repeat radiation. The results (13,17,(34)(35)(36)(37)(38)(39) demonstrated that repeat SABR achieved good efficacy in controlling tumor-related pain (Table 2).…”