scholarly journals Efficacy and toxicity of re-irradiation spine stereotactic body radiotherapy with respect to irradiation dose history

2020 ◽  
Author(s):  
Kei Ito ◽  
Hiroaki Ogawa ◽  
Yujiro Nakajima
Keyword(s):  
Failure Rate ◽  
Stereotactic Body Radiotherapy ◽  
Pain Control ◽  
Irradiation Dose ◽  
Spinal Metastases ◽  
Local Failure ◽  
Dose Fractionation ◽  
Pain Response ◽  
Fractionation Schedule ◽  
Previous Irradiation

Abstract Objective We aimed to clarify the outcomes of re-irradiation stereotactic body radiotherapy for spinal metastases with a uniform dose fractionation schedule at our institution. Methods Data of patients treated with re-irradiation stereotactic body radiotherapy for spinal metastases (September 2013–March 2020) were retrospectively reviewed. The prescribed dose was 24 Gy in two fractions. The spinal cord dose constraint and dose for previously irradiated cases ≥50 Gy in 25 fractions were 12.2 Gy (maximum dose) and 11 Gy, respectively. The endpoints were pain control, local failure and adverse effects. Pain status was measured on a scale of 0–10 using the patients’ self-reports and pain response was defined using international consensus criteria. Local failure was defined as tumor progression on imaging evaluations. Results We assessed 133 lesions in 123 patients, where 70 (52.6%) had three or more spinal levels treated, 58 (43.6%) had previous irradiation doses of 40 Gy or more and 53 (39.8%) had the targets compressing the cord. The median follow-up was 12 months and the 3-, 6- and 12-month pain response rate was 75, 64 and 59%, respectively. The 1-year local failure rate was 25.8%. Previous irradiation dose was not correlated with local failure rate (P = 0.13). Radiation-induced myelopathy, radiculopathy and vertebral compression fractures were observed in 4 (3.0%), 2 (1.5%) and 17 (13.8%) lesions, respectively. A trend towards an association between any toxicity and previous irradiation dose was not observed. Conclusions Re-irradiation spine stereotactic body radiotherapy achieved good local control and pain control, with reduced risk of radiation myelopathy.

A randomized phase II/III study comparing stereotactic body radiotherapy (SBRT) versus conventional palliative radiotherapy (CRT) for patients with spinal metastases (NCT02512965).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS10129-TPS10129 ◽  
Author(s):  
Arjun Sahgal ◽  
Sten Myrehaug ◽  
Kristopher Dennis ◽  
Mitchell Liu ◽  
Edward Chow ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Phase Ii ◽  
Stereotactic Body Radiotherapy ◽  
Spinal Metastases ◽  
Drop Out ◽  
Phase Iii ◽  
Pain Response ◽  
Conventional Radiotherapy ◽  
Randomized Phase Ii ◽  
Phase Iii Study

TPS10129 Background: Innovative radiotherapy technology and modern imaging capabilities enable the use of Stereotactic Body Radiotherapy (SBRT) to treat patients with spinal metastases to optimize tumour control and palliation compared to standard conventional radiotherapy. No randomized clinical trial evidence exists directly comparing the two treatment strategies. Methods: SC.24 is a Canadian Cancer Trials Group randomized phase II/III study comparing standard conventional radiotherapy (20 Gy/5fr) to SBRT (24 Gy/2fr) in patients with solid tumours and MRI documented, painful spinal metastases suitable for RT. The primary accrual objective for the phase II portion of the study was met in January 2017 and the study continues as a randomized phase III study with a primary outcome measure of complete pain response at 3 months post radiotherapy. Secondary objectives include: measurement of complete pain response at 6 months; radiation site progression free survival at 3 and 6 months; adverse event profile, health related QOL and compliance with RT QA measures. Biobanking for future correlative studies is included in study design. Statistical design: The statistical assumptions for the phase III study include estimated complete pain response rates of 10% and 30% for the CRT and SBRT treatment arms respectively. Using a two sided alpha = 0.05 and power = 80% the sample size for the phase III study is 152, taking into account a 5% drop out rate. Conduct to Date: Study activation: July 2015. Accrual to date: 58. Supported by CCSRI grant 021039 Clinical trial information: NCT02512965.

scholarly journals Stereotactic Body Radiotherapy for Frail Patients with Primary Renal Cell Carcinoma: Preliminary Results after 4 Years of Experience

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3129
Author(s):  
Laure Grelier ◽  
Michael Baboudjian ◽  
Bastien Gondran-Tellier ◽  
Anne-Laure Couderc ◽  
Robin McManus ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Stereotactic Body Radiotherapy ◽  
Renal Cell ◽  
Dose Fractionation ◽  
Free Survival ◽  
Primary Renal Cell Carcinoma ◽  
Frail Patients ◽  
Fractionation Schedule ◽  
Tertiary Center

Introduction: The aim of this study was to report the oncological outcomes and toxicity of stereotactic body radiotherapy (SBRT) to treat primary renal cell carcinoma (RCC) in frail patients unfit for surgery or standard alternative ablative therapies. Methods: We retrospectively enrolled 23 patients who had SBRT for primary, biopsy-proven RCC at our tertiary center between October 2016 and March 2020. Treatment-related toxicities were defined using CTCAE, version 4.0. The primary outcome was local control which was defined using the Response Evaluation Criteria in Solid Tumors. Results: The median age, Charlson score and tumor size were 81 (IQR 79–85) years, 7 (IQR 5–8) and 40 (IQR 28–48) mm, respectively. The most used dose fractionation schedule was 35 Gy (78.3%) in five or seven fractions. The median duration of follow-up for all living patients was 22 (IQR 10–39) months. Local recurrence-free survival, event-free survival, cancer-specific survival and overall survival were 96 (22/23), 74 (18/23), 96 (22/23) and 83% (19/23), respectively. There were no grade 3–4 side effects. No patients required dialysis during the study period. No treatment-related deaths or late complications were reported. Conclusion: SBRT appears to be a promising alternative to surgery or ablative therapy to treat primary RCC in frail patients.

scholarly journals Stereotactic body radiotherapy for de novo spinal metastases: systematic review

2017 ◽  
Vol 27 (3) ◽  
pp. 295-302 ◽  
Author(s):  
Zain A. Husain ◽  
Arjun Sahgal ◽  
Antonio De Salles ◽  
Melissa Funaro ◽  
Janis Glover ◽  
...  
Keyword(s):  
Systematic Review ◽  
Local Control ◽  
De Novo ◽  
Spinal Metastases ◽  
Compression Fracture ◽  
Weighted Average ◽  
Dose Fractionation ◽  
Cochrane Library ◽  
Tumor Control ◽  
Pain Response

OBJECTIVEThe aim of this systematic review was to provide an objective summary of the published literature pertaining to the use of stereotactic body radiation therapy (SBRT) specific to previously untreated spinal metastases.METHODSThe authors performed a systematic review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, of the literature found in a search of Medline, PubMed, Embase, and the Cochrane Library up to March 2015. The search strategy was limited to publications in the English language.RESULTSA total of 14 full-text articles were included in the analysis. All studies were retrospective except for 2 studies, which were prospective. A total of 1024 treated spinal lesions were analyzed. The median follow-up time ranged from 9 to 49 months. A range of dose-fractionation schemes was used, the most common of which were 16–24 Gy/1 fraction (fx), 24 Gy/2 fx, 24–27 Gy/3 fx, and 30–35 Gy/5 fx. In studies that reported crude results regarding in-field local tumor control, 346 (85%) of 407 lesions remained controlled. For studies that reported actuarial values, the weighted average revealed a 90% 1-year local control rate. Only 3 studies reported data on complete pain response, and the weighted average of these results yielded a complete pain response rate of 54%. The most common toxicity was new or progressing vertebral compression fracture, which was observed in 9.4% of cases; 2 cases (0.2%) of neurologic injury were reported.CONCLUSIONThere is a paucity of prospective data specific to SBRT in patients with spinal metastases not otherwise irradiated. This systematic review found that SBRT is associated with favorable rates of local control (approximately 90% at 1 year) and complete pain response (approximately 50%), and low rates of serious adverse events were found. Practice guidelines are summarized based on these data and International Stereotactic Radiosurgery Society consensus.

scholarly journals Radiation Therapy without Surgery for Spinal Metastases: Clinical Outcome and Prognostic Factors Analysis for Pain Control

2012 ◽  
Vol 2 (3) ◽  
pp. 137-141
Author(s):  
Akira Matsumura ◽  
Manabu Hoshi ◽  
Masatsugu Takami ◽  
Takahiko Tashiro ◽  
Hiroaki Nakamura
Keyword(s):  
Radiation Therapy ◽  
Prognostic Factors ◽  
Clinical Outcome ◽  
Pain Control ◽  
Spinal Metastases ◽  
Factors Analysis

Melanoma brain metastases harboring BRAF V600K or NRAS mutations are associated with an increased local failure rate following conventional therapy

2017 ◽  
Vol 137 (1) ◽  
pp. 67-75 ◽  
Author(s):  
Penny Fang ◽  
Nicholas S. Boehling ◽  
Eugene J. Koay ◽  
Amanda D. Bucheit ◽  
John A. Jakob ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Failure Rate ◽  
Conventional Therapy ◽  
Local Failure ◽  
Melanoma Brain Metastases
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