Local control of 1-5 fraction radiotherapy regimens for spinal metastases: an analysis of the impacts of biologically effective dose and primary histology.
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ABSTRACT: Background
This analysis evaluates the impacts of biologically effective dose (BED) and histology on local control (LC) of spinal metastases treated with highly conformal radiotherapy to moderately-escalated doses.Materials and methods
Patients were treated at two institutions from 2010-2020. Treatments with less than 5 Gy per fraction or 8 Gy in 1 fraction were excluded. The dataset was divided into three RPA classes predictive of survival (1). The primary endpoint was LC.Results
223 patients with 248 treatments met inclusion criteria. Patients had a median Karnofsky Performance Status (KPS ) of 80, and common histologies included breast (29.4%), non-small cell lung cancer (15.7%), and prostate (13.3%). A median 24 Gy was delivered in 3 fractions (BED: 38.4 Gy) to a median planning target volume (PTV) of 37.3 cc. 2-year LC was 75.7%, and 2-year OS was 42.1%. Increased BED was predictive of improved LC for primary prostate cancer (HR = 0.85, 95% CI: 0.74-0.99). Patients with favorable survival (RPA class 1) had improved LC with BED ≥ 40 Gy (p = 0.05), unlike the intermediate and poor survival groups. No grade 3-5 toxicities were reported.Conclusions
Moderately-escalated treatments were efficacious and well-tolerated. BED ≥ 40 Gy may improve LC, particularly for prostate cancer and patients with favorable survival.
SUBMITTER: Kowalchuk RO
PROVIDER: S-EPMC8726428 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background and purposeSpinal 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 methodsForty-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 set-up (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.ResultsMean 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.ConclusionsSpine 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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Project description:BackgroundAnemia is usually not taken into account in internal radiotherapy. We investigated whether the hemoglobin (Hb) level could have an impact on the tumor response, as observed in external beam radiotherapy (EBRT).MethodsAbsorbed doses of 25 hepatic metastatic sites in eight patients who underwent a liver selective internal radiotherapy (SIRT) were computed by a 3D convolution of a dose deposition kernel with the 90Y time-of-flight positron emission tomography (TOF-PET) images acquired following therapy. Early tumor response was assessed by comparing a follow-up FDG TOF-PET scan with a baseline scan. Hb level was measured on the day of the SIRT procedure.ResultsAll patients displayed early tumor response increasing with the tumor-absorbed dose. Significant differences between patients were noted, the response slope correlating with the Hb level. After applying a global fit on all metastases using a tumor radiosensitivity modulated by a Hb enhancement factor (HEF) linearly dependent on the Hb level, a strong correlation (R?=?0.96) was observed between the early response and the absorbed dose. Hb level had a major impact on tumor response by modulating HEF by a factor 6.ConclusionsThese results prove the significant impact of Hb level on the tumor response and support the study of methods for correcting tumor hypoxia, such as intensively performed in EBRT. The quantitative analysis of the relationship between tumor doses and early response has the power to allow fast screening of such correction methods in limited patient series. Internal radiotherapy could be more efficient if performed earlier in the therapy line, when the disease- and treatment-related anemia remains limited.
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| S-EPMC6378905 | biostudies-other
Project description:Systematic literature review.To summarize the risks of 3 key complications of stereotactic body radiotherapy (SBRT) for spinal metastases, that is, radiation myelopathy (RM), vertebral compression fracture (VCF), and epidural disease progression, and to discuss strategies for minimizing them.RM, VCF and epidural disease progression are now recognized as important risks following SBRT for spine metastases. It is unclear at this stage exactly how large these risks are and what strategies can be employed to minimize these risks.A systematic review of the literature using MEDLINE and a review of the bibliographies of reviewed articles on SBRT for spinal metastases were conducted.The initial literature search revealed a total of 376 articles, of which 38 were pertinent to the study objectives. The risk of RM following SBRT was found to be dependent on the maximum dose to the spinal cord and estimated to be ?5% if the recommended published thecal sac dose constraints are adhered to. The crude risk of VCF was 13.7% (range: 0.7%-40.5%), and, on average, 45% were surgically salvaged. It has been shown that the risk of VCF is dependent on several anatomic and tumor-related factors including the SBRT dose per fraction. The crude risk of local failure at 1 year was 21.4% (range: 12%-27%) of which 67% (range: 38%-96%) occurred within the epidural space. The grade of epidural disease has been shown to be associated with the risk of local failure.The risk of RM after spinal SBRT is low in particular if recommended dose metrics are adhered to. There is a significant risk of both VCF and epidural disease progression after spinal SBRT. These risks can potentially be minimized by identifying the risk factors for these complications, and performing careful radiotherapy and surgical planning.2.
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