Replacing 30 Gy in 10 fractions with stereotactic body radiation therapy for bone metastases: A large multi-site single institution experience 2016–2018
Abstract:Background: Bone metastases cause significant morbidity in patients with cancer, and radiation therapy (RT) is an effective treatment approach. Indications for more complex ablative techniques are emerging. We sought to evaluate RT trends at a large multi-site tertiary cancer center. Methods: Patients who received RT for bone metastases at a single institution (including regional outpatient clinics) from 2016 to 2018 were identified. Patients were grouped by RT regimen: single-fraction conventional RT (8 Gy  … Show more
“…Laufer I et al studied 186 patients who underwent SRT after surgery and reported that high-dose prescription could control radiation-resistant tumors that cannot be controlled well with normal dose fractionation [13]. In the future, we believe SRT may also be used for cases of oligometastases or oligo-recurrence [14]. Our patient had a case of rectal cancer with a tumor that was not highly sensitive to radiation.…”
Many reports indicate that the prognosis of patients with rectal cancer who have thoracic spine metastases with spinal cord compression is poor. Here, we discuss a case of a patient who achieved an improvement of functional prognosis and long-term survival after undergoing surgery and radiotherapy.We report a case of a 64-year-old female who was found to have metastatic spinal cord compression (MSCC) in the second thoracic vertebra, 10 years after surgery for rectal cancer. She experienced numbness in both legs and had gait difficulties. She underwent posterior decompression surgery and radiotherapy. Her neurological symptoms improved after radiotherapy, and the patient could maintain a standing position without assistance within one week after irradiation. She has since received adjuvant chemotherapy and continues to survive five years six months since MSCC onset.
“…Laufer I et al studied 186 patients who underwent SRT after surgery and reported that high-dose prescription could control radiation-resistant tumors that cannot be controlled well with normal dose fractionation [13]. In the future, we believe SRT may also be used for cases of oligometastases or oligo-recurrence [14]. Our patient had a case of rectal cancer with a tumor that was not highly sensitive to radiation.…”
Many reports indicate that the prognosis of patients with rectal cancer who have thoracic spine metastases with spinal cord compression is poor. Here, we discuss a case of a patient who achieved an improvement of functional prognosis and long-term survival after undergoing surgery and radiotherapy.We report a case of a 64-year-old female who was found to have metastatic spinal cord compression (MSCC) in the second thoracic vertebra, 10 years after surgery for rectal cancer. She experienced numbness in both legs and had gait difficulties. She underwent posterior decompression surgery and radiotherapy. Her neurological symptoms improved after radiotherapy, and the patient could maintain a standing position without assistance within one week after irradiation. She has since received adjuvant chemotherapy and continues to survive five years six months since MSCC onset.
“…In the palliative setting, a phase II randomized controlled trial showed single fraction SBRT to be non-inferior to multi-fraction conventional RT, with higher rates of pain response in those receiving SBRT [57] . We favor using conventional RT for bone metastases in most cases, with SBRT reserved for patients at high risk for recurrence, in particular those with radioresistant tumors or prolonged expected survival [5] .…”
Section: Resultsmentioning
confidence: 99%
“…While comprehensive multidisciplinary guidelines exist for spinal metastases [2] , national guidelines for the management of non-spine bone metastases have traditionally focused on radiation therapy (RT) to palliate pain, and surgical intervention and bone modifying agents to treat or prevent pathologic fractures [3] , [4] . A recent review showed the most common locations for these lesions include the hip/pelvis, ribs, shoulder, and femur and comprise 46% of all bone metastases treated in a tertiary radiation oncology center [5] . However, as systemic therapies have evolved and options for local therapy have increased, the utility of existing guidelines in routine care is increasingly limited.…”
“…Nguyen et al [27] found in a phase II trial that SBRT had higher rates of pain response. Indeed, several studies have been published comparing the effectiveness between SBRT and conventional RT [32][33][34][35][36][37]. Indeed, there are potential disadvantages of SBRT, including possible increased pain flare or a higher incidence of radiation-induced fractures [38].…”
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