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Spine Stereotactic Body Radiotherapy to Three or More Contiguous Vertebral Levels
Khaled Dibs1, Dukagjin M Blakaj1, Rahul N Prasad1
1Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, United States.
Frontiers in Oncology
|June 27, 2022
Summary
Stereotactic body radiotherapy (SBRT) for spine metastases involving 3 or more contiguous levels is feasible and effective. This treatment offers excellent local control and minimal toxicity, supporting its use in select patients.
Area of Science:
- Oncology
- Radiation Oncology
- Spine Metastases Management
Background:
- Spine metastases are a growing cause of morbidity as cancer survival improves.
- Durable local control (LC) is crucial for managing spine metastases.
- Stereotactic body radiotherapy (SBRT) shows promise for improved LC and palliation, but its use for ≥3 contiguous levels is limited due to setup concerns.
Purpose of the Study:
- To evaluate the feasibility, toxicity, and cancer control outcomes of spine SBRT in patients with ≥3 contiguous involved levels.
- To compare outcomes between patients treated with SBRT to 1-2 levels versus ≥3 contiguous levels.
- To identify factors associated with local failure after spine SBRT.
Main Methods:
- Retrospective review of SBRT courses for spine metastases (2013-2019).
- Stratification into 1-2 contiguous levels and ≥3 contiguous levels groups.
- Primary endpoint: 1-year local control (LC); secondary endpoints: toxicity, local failure (LF) predictors, and dosimetric analysis.
Main Results:
- 1-year LC was 88% overall (89% for 1-2 levels vs. 84% for ≥3 levels, p=0.747).
- Uncontrolled systemic disease was the only factor associated with inferior LC in the ≥3 levels group.
- No significant differences in fracture rates or severe toxicities (grade 3+) were observed between groups.
Conclusions:
- Spine SBRT is feasible for ≥3 contiguous levels, offering excellent local control and acceptable toxicity.
- Further prospective studies are warranted to confirm these findings.
- SBRT can be a viable option for carefully selected patients with extensive spine involvement.
