Stereotactic body radiotherapy is an effective treatment in reirradiating spinal metastases: current status and practical considerations for safe practice

Masucci, Giuseppina Laura; Yu, Eugene; Ma, Lijun; Chang, Eric L.; Létourneau, D.; Lo, Simon S.; Leung, Eric; Chao, Samuel T.; Hyde, Derek; Gorgulho, Alessandra; Muacevic, A.; Larson, David A.; Fehlings, Michael G.; Sahgal, Arjun

doi:10.1586/era.11.169

Cited by 49 publications

(36 citation statements)

References 28 publications

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“…tions, 24 to 30 Gy in 2-3 fractions, and 16 to 24 Gy in a single fraction), 8,12,14 we are learning that although we can achieve high rates of local tumor control, the costs include bone and spinal cord toxicity. 1,2,11,15,16,18 Our group at the University of Toronto recently reported rates of post-SRS VCF.…”

mentioning

confidence: 99%

Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation

Al-Omair

Smith²,

Kiehl

et al. 2013

SPI

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Spine SRS, also known as stereotactic body radiotherapy, is increasingly being applied to treat primary and metastatic spinal tumors.12,13 Spine SRS is a paradigm shift from conventional radiotherapy practice, where the aim is to deliver low dose-per-fraction treatments (1.8-4.0 Gy per day) daily to a total dose limited by the tolerance of the spinal cord. Spine SRS overcomes this convention by using modern radiation technologies that allow for concentrating the dose within the tumor and away from the spinal cord, to permit tumor dose escalation while maintaining safe spinal cord dose constraints. 5 Delivery precision has been reported to be within 1.5 mm and 1° with a 95% confidence interval. Recently, the Canadian Association of Radiation Oncology defined stereotactic body radiotherapy (including as it pertains to the spine) as "The precise delivery of highly conformal and image-guided hypofractionated external beam radiotherapy, delivered in a single or few fraction(s), to an extracranial body target with doses at least biologically equivalent to a radical course when given over a protracted conventionally fractionated schedule."17 Philosophically, this translates to delivering a "locally curative" dose as opposed to a "locally palliative" dose for spinal metastatic disease. As experience with high dose-per-fraction spine SRS is gained (such that the most common practices range from 30 to 40 Gy in 5 frac- Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral compression fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progression has occurred, the authors recommend biopsy to rule out radiation-induced effects within the bone prior to initiating salvage therapies.

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confidence: 99%

Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation

Al-Omair

Smith²,

Kiehl

et al. 2013

SPI

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“…This allows the system to automatically compare this marker information with reference information to move the treatment couch to the desired position [20]. Gill et al commenting on local control and toxicity of SBRT of single vertebrae spinal tumors reported that a doses of [30][31][32][33][34][35] Gy were given via Cyberknife technology, and at 34 months median follow-up (IQR, 25-40 months) for surviving patients, the 1-and 2-year Kaplan-Meier local control estimates were 80 and 73%, respectively [21]. In effect, SBRT for primary or metastatic spinal column cancers is a noninvasive procedure with excellent control rates that is being widely adopted by radiation oncologists across the United States.…”

Section: Sbrt For Spinal Column Tumorsmentioning

confidence: 99%

“…In SBRT, sophisticated imaging is combined with multiple radiation beams, up to 254 in some instances, to deliver a high dose of concentrated radiation to the tumor. Although each individual beam is weak, the collective energy at the intersection of the beams provides high doses of radiation to the tumor [32]. In general, a larger number of beams yields better target dose conformity and dose fall-off away from the target.…”

Section: Planning and Procedures Effective Radiation Gy Imaging And mentioning

confidence: 99%

Stereotactic Body Radiation Therapy: A Review of Applications and Outcomes

Rajeev¹,

ey²,

Gurumurthy³

et al. 2015

J Nucl Med Radiat Ther

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Radiotherapy is a versatile tool used in the treatment of various types of benign and malignant neoplasms. However, conventional radiation therapy for cancerous conditions often results in collateral damage to healthy tissues due to involvement of oversized radiation fields. Over the last decade one type of precision based radiation treatment has developed. This new treatment, known as Stereotactic Radiosurgery (SRS), involves highly accurate beams of high-energy radiation that are used to destroy abnormal cells by permanently damaging their DNA. As technology progressed stereotactic cranial radiosurgery developed into a successful method for certain tumorous conditions of the head and skull. The success of stereotactic cranial radiosurgery led to further radiation application research to widen the spectrum of treatable conditions to include those located extracranially. The result of this continued research led to the development of stereotactic body radiation therapy (SBRT), a radiotherapy technique based upon principles of SRS that is used to treat small or moderate sized tumors of the body with a limited number of treatments. Stereotactic body radiation therapy combines the use of the latest tumor imaging technology as well as precision based radiation delivery mechanisms to overcome physiological barriers of normal radiation therapy such as movement of tumors in tissues. The net effect of SBRT is that a dose of radiation much larger than normal can be administered in a very precise manner, over smaller time frame, bringing about a dramatic tumor response. In this review the authors will attempt to briefly cover the subject of stereotactic body radiation therapy as well as its applications and effectiveness.

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“…Patients could benefit from hypofractionated or single‐fraction schedules 10 , 11 , 12 . Outcome data show high rates of local control and pain control for spine metastases treated with SBRT, and suggest better efficacy than with conventional palliative radiotherapy 11 , 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

Intensity‐modulated radiotherapy versus proton radiotherapy versus carbon ion radiotherapy for spinal bone metastases: a treatment planning study

Rief

Chaudhri

Tonndorf-Martini

et al. 2015

J Applied Clin Med Phys

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Outcomes for selected patients with spinal metastases may be improved by dose escalation using stereotactic body radiotherapy (SBRT). As target geometry is complex, we compared SBRT plans using step‐and‐shoot intensity‐modulated radiotherapy (IMRT), carbon ion RT, and proton RT. We prepared plans treating cervical, thoracic, and lumbar metastases for three different techniques — IMRT, carbon ion, and proton plans — to deliver a median single 24 Gy fraction such that at least 90% of the planning target volume (PTV) received more than 18 Gy and were compared for PTV coverage, normal organ sparing, and estimated delivery time. PTV coverage did not show significant differences for the techniques, spinal cord dose sparing was lowered with the particle techniques. For the cervical lesion spinal cord maximum dose, dose of 1% (D1), and percent volume receiving 10 Gy (normalV10Gy) were 11.9 Gy, 9.1 Gy, and 0.5% in IMRT. This could be lowered to 4.3 Gy, 2.5 Gy, and 0% in carbon ion planning and to 8.1 Gy, 6.1 Gy, and 0% in proton planning. Regarding the thoracic lesion no difference was found for the spinal cord. For the lumbar lesion maximum dose, D1 and percent volume receiving 5 Gy (normalV5Gy) were 13.4 Gy, 8.9 Gy, and 8.9% for IMRT; 1.8 Gy, 0.7 Gy, and 0% for carbon ions; and 0 Gy,<0.01 Gy, and 0% for protons. Estimated mean treatment times were shorter in particle techniques (6–7 min vs. 12–14 min with IMRT). This planning study indicates that carbon ion and proton RT can deliver high‐quality PTV coverage for complex treatment volumes that surround the spinal cord.PACS number: 87.55.dk

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Stereotactic body radiotherapy is an effective treatment in reirradiating spinal metastases: current status and practical considerations for safe practice

Cited by 49 publications

References 28 publications

Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation

Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation

Stereotactic Body Radiation Therapy: A Review of Applications and Outcomes

Intensity‐modulated radiotherapy versus proton radiotherapy versus carbon ion radiotherapy for spinal bone metastases: a treatment planning study

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