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Stereotactic radiotherapy for bone oligometastases.

Caterina Colosimo1, Francesco Pasqualetti2, Cynthia Aristei3

  • 1Operative Unit of Radiotherapy, Department of Oncology, San Luca Hospital, Lucca, Italy.

Reports of Practical Oncology and Radiotherapy : Journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology
|April 11, 2022
PubMed
Summary

Bone metastases affect many cancer patients, especially in the spine. Advanced imaging like PET-CT and stereotactic radiotherapy (SRT) offer high accuracy and effective treatment with low toxicity for spinal metastases.

Keywords:
bone metastaseshypofractionationlocal controloligometastasisradiosurgeryspine metastasesstereotactic radiotherapytoxicity

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Area of Science:

  • Oncology
  • Radiotherapy
  • Medical Imaging

Background:

  • Bone metastases are a common complication in cancer patients, frequently affecting the spine.
  • Current imaging modalities include bone scintigraphy, CT, and MRI.
  • Positron emission tomography/computed tomography (PET-CT) offers high sensitivity and specificity (approx. 95%) for diagnosing metastatic bone disease.

Purpose of the Study:

  • To review current imaging techniques for bone metastases.
  • To discuss the role of PET-CT and novel radiotracers in cancer diagnosis.
  • To outline treatment planning and stereotactic radiotherapy (SRT) guidelines for spine metastases.

Main Methods:

  • Review of current imaging modalities: bone scintigraphy, CT, MRI, and PET-CT.
  • Discussion of radiotracers including 18F-fluorodeoxyglucose (18FDG), 11C/18FDG-choline, and PSMA-PET/CT.
  • Analysis of International Spine Radiosurgery Consortium (ISRC) guidelines for spine metastasis target volume delineation.
  • Evaluation of stereotactic radiotherapy (SRT) dosing and fractionation schedules.

Main Results:

  • PET-CT demonstrates high diagnostic accuracy (approx. 95%) for metastatic bone disease.
  • Various radiotracers are under investigation for improved tumor detection.
  • SRT doses for spine metastases range from 12-24 Gy (single fraction) to 21-35 Gy (fractionated).
  • Spine SRT shows low acute toxicity (<5% grade ≥ 3).

Conclusions:

  • PET-CT is a valuable tool for assessing bone metastases, with ongoing research into novel radiotracers.
  • SRT is an effective treatment for spine metastases, offering high accuracy and manageable toxicity.
  • Late toxicity risks include rare radiation-induced myelopathy and a 14% risk of vertebral compression fractures.