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Published on: May 8, 2018
Prospective Evaluation of Stereotactic Body Radiation Therapy for Reirradiation of Bone Metastases
Lubna Hammoudeh1, Kee-Young Shin2, Lauren Hertan3
1Radiation Oncology Department, Mass General Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
Purpose:
Bone metastases are a common cause of morbidity among patients with cancer, and radiation therapy (RT) is efficacious for their palliation. However, symptomatic bone metastases can often occur in regions that have received prior RT, limiting doses that can be delivered safely. Stereotactic body radiation therapy (SBRT) enables the delivery of greater doses of RT to the tumor while minimizing reirradiation dose to critical organs at risk.
Methods And Materials:
In this prospective, multi-institutional phase 2 trial, 45 patients with bone metastasis in a previously irradiated region were treated with SBRT from February 2017 to November 2021. The primary endpoint was local control at 6 months post RT; secondary aims were rates of acute and chronic toxicity, time to local progression, local progression rate, progression-free survival, and overall survival.
Results:
The median age of participants was 62.6 years, and most were male (75.6%). The most common primary tumor types were as follows: prostate (13/45, 28.9%), lung (8/45, 17.8%), and renal cell (5/45, 11.1%). The majority received reirradiation to a spinal lesion (35/45, 77.7%). The most common dose prescriptions were 30 Gy in 5 fractions (24/45, 53.3%) and 35 Gy in 5 fractions (11/45, 24.4%). At 6 months, 42 of 45 treated sites were locally controlled, whereas 3 had progressed at a median of 3.6 months. The local progression-free rate was 89.9% at 2 years. Overall survival was 52% at 2 years. Acute toxicities occurred in 46.7%, most commonly fatigue, nausea, and pain flare; all were grade 1 or 2. In total, 8.9% of participants experienced chronic toxicities, including vertebral fracture and pain flare, all grade 1 or 2 with no myelopathies.
Conclusions:
This prospective study of SBRT for reirradiation of bone metastases demonstrated effective local control and reasonable rates of acute and chronic toxicities. Additional research is needed to further ascertain long-term efficacy and treatment-related toxicities.
