40 Gray in 5 Fractions for Salvage Reirradiation of Spine Lesions Previously Treated With Stereotactic Body Radiotherapy

A retrospective single-center analysis of the safety and efficacy of reirradiation to 40 Gy in 5 fractions (reSBRT) in patients previously treated with stereotactic body radiotherapy to the spine was performed. We identified 102 consecutive patients treated with reSBRT for 105 lesions between 3/2013...

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Bibliographic Details
Published in:	Neurosurgery Vol. 95; no. 2; p. 380
Main Authors:	Moore, Assaf, Zhang, Zhigang, Fei, Teng, Zhang, Lei, Accomando, Laura, Schmitt, Adam M, Higginson, Daniel S, Mueller, Boris A, Zinovoy, Melissa, Gelblum, Daphna Y, Yerramilli, Divya, Xu, Amy J, Brennan, Victoria S, Guttmann, David M, Grossman, Craig E, Dover, Laura L, Shaverdian, Narek, Pike, Luke R G, Cuaron, John J, Dreyfuss, Alexandra, Lis, Eric, Barzilai, Ori, Bilsky, Mark H, Yamada, Yoshiya
Format:	Journal Article
Language:	English
Published:	United States 01-08-2024
Online Access:	Get full text
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Summary:	A retrospective single-center analysis of the safety and efficacy of reirradiation to 40 Gy in 5 fractions (reSBRT) in patients previously treated with stereotactic body radiotherapy to the spine was performed. We identified 102 consecutive patients treated with reSBRT for 105 lesions between 3/2013 and 8/2021. Sixty-three patients (61.8%) were treated to the same vertebral level, and 39 (38.2%) to overlapping immediately adjacent levels. Local control was defined as the absence of progression within the treated target volume. The probability of local progression was estimated using a cumulative incidence curve. Death without local progression was considered a competing risk. Most patients had extensive metastatic disease (54.9%) and were treated to the thoracic spine (53.8%). The most common regimen in the first course of stereotactic body radiotherapy was 27 Gy in 3 fractions, and the median time to reSBRT was 16.4 months. At the time of simulation, 44% of lesions had advanced epidural disease. Accordingly, 80% had myelogram simulations. Both the vertebral body and posterior elements were treated in 86% of lesions. At a median follow-up time of 13.2 months, local failure occurred in 10 lesions (9.5%). The 6- and 12-month cumulative incidences of local failure were 4.8% and 6%, respectively. Seven patients developed radiation-related neuropathy, and 1 patient developed myelopathy. The vertebral compression fracture rate was 16.7%. In patients with extensive disease involvement, reSBRT of spine metastases with 40 Gy in 5 fractions seems to be safe and effective. Prospective trials are needed to determine the optimal dose and fractionation in this clinical scenario.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0148-396X 1524-4040 1524-4040
DOI:	10.1227/neu.0000000000002889