Spine stereotactic body radiotherapy for renal cell cancer spinal metastases: analysis of outcomes and risk of vertebral compression fracture

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The aim of this study was to evaluate local control (LC) and the risk of vertebral compression fracture (VCF) after stereotactic body radiotherapy (SBRT) in patients with renal cell cancer spinal metastases.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Prospectively collected data on 71 spinal segments treated with SBRT in 37 patients were reviewed. The median follow-up was 12.3 months (range 1.2–55.4 months). The LC rate was assessed based on each spinal segment treated and overall survival (OS) according to each patient treated. Sixty of 71 segments (85%) were radiation naive, 11 of 71 (15%) were previously irradiated, and 10 of 71 (14%) were treated with postoperative SBRT. The median SBRT total dose and number of fractions were 24 Gy and 2, respectively. The VCF analysis also included evaluation of the Spinal Instability Neoplastic Score criteria.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The 1-year OS and LC rates were 64% and 83%, respectively. Multivariate analysis identified oligometastatic disease (13 of 37 patients) as a positive prognostic factor (p = 0.018) for OS. Of 61 non-postoperative spinal segments treated, 10 (16%) developed VCFs; 3 of 10 were de novo VCFs and 7 of 10 occurred as progression of an existing VCF. The 1-year VCF-free probability rate was 82%. Multivariate analysis identified single-fraction SBRT and baseline VCF as significant predictors of SBRT-induced VCF (p = 0.028 and p = 0.012, respectively).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Spine SBRT yields high rates of local tumor control in patients with renal cell cancer. Baseline VCF and 18–24 Gy delivered in a single fraction were predictive of further collapse. Patients with oligometastatic disease may benefit most from such aggressive local therapy, given the prolonged survival observed.</jats:p></jats:sec>

The use of spine stereotactic radiosurgery for oligometastatic disease

“…3,21,29 Stereotactic body radiation therapy is a less-invasive alternative to surgery and appears to offer acceptable local control and survival rates for patients with limited metastatic disease. 16,17,30 It is currently the subject of several ongoing clinical trials, examining the value of stereotactic body radiation therapy in oligometastatic disease for various primary sites.…”

“…Thibault et al reviewed patients with renal cell cancer treated with SSRS and showed that patients with oligometastatic disease had an improved survival compared with those with more numerous metastases (1-year survival of 84% vs 53%). 30 Gill et al reported on 20 patients with oligometastatic spinal metastases treated with Cyberknife SSRS to a median dose of 30 Gy in 5 fractions.…”

Five-Year Outcomes of High-Dose Single-Fraction Spinal Stereotactic Radiosurgery

“…13 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) Gy in 5-6 fractions; p = 0.09) following separation surgery, with 11 month median follow-up for survivors. 5 Moulding, et al, also in the adjuvant setting for metastases, reported achievement of an estimated 1-year 6.3% failure risk with this regime.…”

Paradigmaváltás a csontmetasztázisok sebészetében. II. Gerincmetasztázisok kezelése

“…A magasabb SINS-érték szignifikánsan összefüggésbe hozható a sugárkezelés ismétlésének szükségességével [14] és a gerinc sugárkezelését követő mellékhatások, komplikációk előfordulásával [15]. A műtéti beavatkozás esetén a túl-élés és a SINS-pontszám között nem találtak szignifikáns összefüggést, de a magasabb SINS-pontszám esetén bekövetkező patológiás törés szignifikánsan csökkenti az életminőséget [16][17][18].…”