Stereotactic Body Radiotherapy (SBRT) for Oligometastatic Spine Metastases: An Overview

Zeng, Kang; Tseng, Chia‐Lin; Soliman, Hany; Weiss, Yonatan; Sahgal, Arjun; Myrehaug, Sten

doi:10.3389/fonc.2019.00337

Cited by 81 publications

(63 citation statements)

References 108 publications

(98 reference statements)

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“…As an alternative, stereotactic body RT (SBRT) allows for the delivery of ablative doses to small volumes with a steep dose gradient to spare surrounding normal structures. Although SBRT is increasingly used in adult patients for the treatment of oligometastatic disease, 36‐44 to our knowledge there are limited data regarding its safety and efficacy in a pediatric population 45,46 . There is a particularly strong rationale for SBRT in this population as a strategy to reduce dose to nontarget tissues and potentially reduce the late effects of RT.…”

Section: Introductionmentioning

confidence: 99%

A multi‐institutional phase 2 trial of stereotactic body radiotherapy in the treatment of bone metastases in pediatric and young adult patients with sarcoma

Elledge

Krasin

Ladra

et al. 2020

Cancer

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Background Metastasectomy is standard of care for pediatric patients with metastatic sarcoma with limited disease. For patients with unresectable disease, stereotactic body radiotherapy (SBRT) may serve as an alternative. Herein, the authors report the results of a prospective, multi‐institutional phase 2 trial of SBRT in children and young adults with metastatic sarcoma. Methods Patients aged >3 years and ≤40 years with unresected, osseous metastatic nonrhabdomyosarcoma sarcomas of soft tissue and bone were eligible. Patients received SBRT to a dose of 40 Gray (Gy) in 5 fractions. Local control (LC), progression‐free survival (PFS), and overall survival (OS) were calculated using the Kaplan‐Meier method. Results Fourteen patients with a median age of 17 years (range, 4‐25 years) were treated to 37 distinct metastatic lesions. With a median follow‐up of 6.8 months (30.5 months in surviving patients), the Kaplan‐Meier patient‐specific and lesion‐specific LC rates at 6 months were 89% and 95%, respectively. The median PFS was 6 months and the median OS was 24 months. In a post hoc analysis, PFS (median, 9.3 months vs 3.7 months; log‐rank P = .03) and OS (median not reached vs 12.7 months; log‐rank P = .02) were improved when all known sites of metastatic disease were consolidated with SBRT compared with partial consolidation. SBRT was well tolerated, with 2 patients experiencing grade 3 toxicities. Conclusions SBRT achieved high rates of LC in pediatric patients with inoperable metastatic nonrhabdomyosarcoma sarcomas of soft tissue and bone. These results suggest that the ability to achieve total consolidation of metastatic disease with SBRT is associated with improved PFS and OS.

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Section: Introductionmentioning

confidence: 99%

A multi‐institutional phase 2 trial of stereotactic body radiotherapy in the treatment of bone metastases in pediatric and young adult patients with sarcoma

Elledge

Krasin

Ladra

et al. 2020

Cancer

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“…The safety and efficacy of stereotactic body radiotherapy (SBRT) for spinal metastases have been demonstrated in retrospective and prospective phase I/II trials, showing higher rates of local control and faster and longer pain relief [5][6][7][8][9]. The issue is of particular relevance in oligometastatic patients even due to the potentially relevant impact on the oncological outcome [5,8,9] Given the delivery of high doses in a small number of fractions (typically 1-5) and the proximity of the spinal cord dose distributions with steep dose gradients outside the planning target volume (PTV) need to be delivered. Consequently, in order to avoid potential adverse effects [10][11][12][13], sufficiently high geometric accuracy is required.…”

Section: Introductionmentioning

confidence: 99%

“…Higher doses and individualized treatments have been recommended in this patient setting. The safety and efficacy of stereotactic body radiotherapy (SBRT) for spinal metastases have been demonstrated in retrospective and prospective phase I/II trials, showing higher rates of local control and faster and longer pain relief [5] , [6] , [7] , [8] , [9] . The issue is of particular relevance in oligometastatic patients even due to the potentially relevant impact on the oncological outcome [5] , [8] , [9] …”

Section: Introductionmentioning

confidence: 99%

Residual intra-fraction error in robotic spinal stereotactic body radiotherapy without immobilization devices

Rossi

Fiorino

Fodor

et al. 2020

Physics and Imaging in Radiation Oncology

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Background and purpose: Spinal stereotactic body radiotherapy (SBRT) involves large dose gradients and high geometrical accuracy is therefore required. The aim of this work was to assess residual intra-fraction error with a tracking robotic system for non-immobilized patients. Shifts from the first alignment (i.e. mimicking the unavailability of tracking) were also quantified. Materials and methods: Forty-two patients treated for spinal metastasis (128 fractions, 4220 images) were analyzed. Residual error was quantified as the difference between translations/rotations referring to consecutive x-ray images during delivery (tracking) and to the initial setup (no-tracking). The error distribution for each fraction/patient and the entire population was assessed for each axis/rotation angle. The impact of lesion sites, fractionation and patient's pain (VAS score) were investigated. Finally, the dosimetric impact of residual motion was quantified in the four most affected fractions. Results: Mean overall errors (OE) were near 0 (SD < 0.1 mm). Residual translations/rotations >1 mm/1 • were found in less than 1.5%/1% of measurements. Lesion site and fractionation showed no impact. The dosimetric impact in the most affected fractions was negligible. For "no-tracking", mean OE was <1 mm/0.5 • ; less than 2% of displacements were >2 mm/1 • within 10 min from the start of treatment with an increasing probability of shifts >2 mm over time. A significantly higher fraction of OE ≥ 2 mm was found for patients with pain in case of no-tracking. Conclusions: Spine tracking with a latest-generation robotic system is highly efficient for non-immobilized patients: residual error is time independent and close to 0. For delivery times >7-8 min, tracking should be considered as mandatory for non-immobilized patients.

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“…5 Single institution studies demonstrate an advantage of using SRS/SBRT in terms of increased local control and complete response compared to conventional three-dimensional conformal radiotherapy (3DCRT). [6][7][8][9][10][11][12][13] Sprave et al 14 3 (none of which were spine) of 66 the patients after SABR, compared to none (n = 33) in the control group. 15 The most feared complication from spine SRS is radiation myelopathy.…”

Section: Introductionmentioning

confidence: 98%

Full automation of spinal stereotactic radiosurgery and stereotactic body radiation therapy treatment planning using Varian Eclipse scripting

Teruel¹,

Malin²,

Liu³

et al. 2020

J Applied Clin Med Phys

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The purpose of this feasibility study is to develop a fully automated procedure capable of generating treatment plans with multiple fractionation schemes to improve speed, robustness, and standardization of plan quality. A fully automated script was implemented for spinal stereotactic radiosurgery/stereotactic body radiation therapy (SRS/SBRT) plan generation using Eclipse v15.6 API. The script interface allows multiple dose/fractionation plan requests, planning target volume (PTV) expansions, as well as information regarding distance/overlap between spinal cord and targets to drive decision‐making. For each requested plan, the script creates the course, plans, field arrangements, and automatically optimizes and calculates dose. The script was retrospectively applied to ten computed tomography (CT) scans of previous cervical, thoracic, and lumbar spine SBRT patients. Three plans were generated for each patient — simultaneous integrated boost (SIB) 1800/1600 cGy to gross tumor volume (GTV)/PTV in one fraction; SIB 2700/2100 cGy to GTV/PTV in three fractions; and 3000 cGy to PTV in five fractions. Plan complexity and deliverability patient‐specific quality assurance (QA) was performed using ArcCHECK with an Exradin A16 chamber inserted. Dose objectives were met for all organs at risk (OARs) for each treatment plan. Median target coverage was GTV V100% = 87.3%, clinical target volume (CTV) V100% = 95.7% and PTV V100% = 88.0% for single fraction plans; GTV V100% = 95.6, CTV V100% = 99.6% and PTV V100% = 97.2% for three fraction plans; and GTV V100% = 99.6%, CTV V100% = 99.1% and PTV V100% = 97.2% for five fraction plans. All plans (n = 30) passed patient‐specific QA (>90%) at 2%/2 mm global gamma. A16 chamber dose measured at isocenter agreed with planned dose within 3% for all cases. Automatic planning for spine SRS/SBRT through scripting increases efficiency, standardizes plan quality and approach, and provides a tool for target coverage comparison of different fractionation schemes without the need for additional resources.

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Stereotactic Body Radiotherapy (SBRT) for Oligometastatic Spine Metastases: An Overview

Cited by 81 publications

References 108 publications

A multi‐institutional phase 2 trial of stereotactic body radiotherapy in the treatment of bone metastases in pediatric and young adult patients with sarcoma

A multi‐institutional phase 2 trial of stereotactic body radiotherapy in the treatment of bone metastases in pediatric and young adult patients with sarcoma

Residual intra-fraction error in robotic spinal stereotactic body radiotherapy without immobilization devices

Full automation of spinal stereotactic radiosurgery and stereotactic body radiation therapy treatment planning using Varian Eclipse scripting

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