spine cancer - sbrt treatment of previously irradiated progressive spine mets - md anderson
DESCRIPTION
Reirradiation for progressive spinal metastases with stereotactic body radiotherapy results in good local control and limited toxicity.Cyberknife is the first and only dedicated 'Frameless' SRS/SBRT system available for removing cancerous and non-cancerous tumors throughout the body. Cyberknife is the most advanced technology for delivering SRS/SBRT treatments. It not only utilizes sophisticated image guidance but it is also the only system that has extremely advanced Tumor Tracking. Always on Target, Cyberknife treats tumors fixed or in motion with sub-millimeter accuracy, reducing, even limiting side effects and complications. And treatments are completed in 5 days or less.TRANSCRIPT
Prospective evaluation of spinal reirradiation by using stereotactic body radiation therapy: The University of Texas MD Anderson Cancer Center experience. Garg AK, Wang XS, Shiu AS, Allen P, Yang J, McAleer MF, Azeem S, Rhines LD, Chang EL.
Source
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Abstract
BACKGROUND:
Stereotactic body radiotherapy for previously irradiated, progressive spinal metastases may be a viable
option in selected patients. The authors review a prospective series of spinal metastasis patients
reirradiated with stereotactic body radiotherapy.
METHODS:
A total of 59 patients with 63 tumors of the spine were reirradiated with stereotactic body radiotherapy
between 2003 and 2009. Spinal magnetic resonance imaging was performed both before treatment
initiation and at regular follow-up intervals. Stereotactic body radiotherapy was delivered to a peripheral
dose of 30 grays (Gy) in 5 fractions (6 Gy per fraction), or 27 Gy in 3 fractions (9 Gy per fraction). The
National Cancer Institute Common Toxicity Criteria 2.0 and McCormick neurological function system were
used to evaluate toxicity and neurologic status, respectively.
RESULTS:
Mean follow-up was 17.6 months. Actuarial 1-year radiographic local control and overall survival for all
patients were both 76%. Of the tumors that progressed after stereotactic body radiotherapy, 13 (81%) of
16 patients had tumors that were within 5 mm of the spinal cord, and 6 of them eventually developed
spinal cord compression. Toxicity was most commonly grade 1 or 2 fatigue. Two patients experienced
mild to moderate radiation injury (lumbar plexopathy) while remaining independently ambulatory and pain
free. Freedom from neurologic deterioration from any cause was 92% at 1 year.
CONCLUSIONS:
Reirradiation for progressive spinal metastases with stereotactic body radiotherapy results in good local
control and limited toxicity. Initial surgery should be considered for tumors within 5 mm of the spinal cord.
Radiation dose should be tailored for tumors near or invading the psoas muscle secondary to observed
risk of lumbar plexopathy.
Copyright © 2011 American Cancer Society.