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Increased Dose in Spine Stereotactic Radiosurgery for Metastatic Disease: Are We Underestimating the Risks?
Gil Kimchi1,2, Maya Nulman1, Saeda Haj3
1Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 5262000, Israel.
Medicina (Kaunas, Lithuania)
|September 28, 2024
Summary
Spine stereotactic radiosurgery (SSRS) using doses of 18 Gy or lower shows high local control rates and low complications. Current guidelines recommending higher doses may not be universally applicable for spinal metastatic disease.
Area of Science:
- Oncology
- Radiation Oncology
- Neurosurgery
Background:
- Recent ESTRO guidelines recommend against Spine Stereotactic Radiosurgery (SSRS) doses ≤18 Gy for spinal metastases.
- These guidelines prioritize local control over potential complications.
Purpose of the Study:
- To evaluate the necessity and validity of higher SSRS dose recommendations.
- To assess outcomes and complications associated with lower radiation doses in SSRS.
Main Methods:
- Retrospective evaluation of 149 SSRS treatment sessions across 242 spinal levels.
- Comparison of patient outcomes and complications with existing literature and ESTRO guideline data.
Main Results:
- Overall local control rate was 91.2%.
- Mean radiation doses in local control vs. local failure groups were similar (17.5 Gy vs. 17.6 Gy).
- Overall complication rate was 6%.
Conclusions:
- SSRS dose escalation may improve local control but increases complication risks.
- Current evidence supporting higher dose recommendations in ESTRO guidelines is not robust for universal application.
- Individualized SSRS dose decisions considering patient factors and risk-benefit analysis are crucial for metastatic spinal disease management.
