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Reirradiation With Three-Fraction Stereotactic Body Radiation Therapy for Spinal Metastases.
Christopher B Jackson1, Lei Zhang2, Justin Haseltine1
1Departments of Radiation Oncology.
Practical Radiation Oncology
|March 5, 2026
Summary
Re-irradiation with 3-fraction spine SBRT is safe, achieving an 85% local control rate at two years for patients with prior radiation. Lower PTV DMin and GI histology increased local failure risk.
Area of Science:
- Radiation Oncology
- Spine Tumors
- Stereotactic Body Radiation Therapy (SBRT)
Background:
- Spine stereotactic body radiation therapy (SBRT) is increasingly used for re-irradiation.
- Characterizing outcomes is crucial for optimizing treatment strategies.
Purpose of the Study:
- To evaluate local failure (LF) and toxicity after 3-fraction spine SBRT in patients with prior radiation.
- To identify factors associated with local failure in this setting.
Main Methods:
- Retrospective analysis of 83 patients treated with 3-fraction spine SBRT between 2014-2023.
- Primary outcome: local failure (LF) on MRI. Secondary outcomes: vertebral compression fracture (VCF) and radiation myelitis (RM).
- Univariable analysis assessed factors influencing LF, including PTV DMin and histology.
Main Results:
- The 1- and 2-year LF rates were 8.4% and 15%, respectively.
- Median follow-up was 14.2 months; median overall survival was 20.5 months.
- Lower PTV DMin (HR 0.85) and GI histology (HR 5.6) were associated with increased LF risk. VCF occurred in 5.5% and RM in 1.3%.
Conclusions:
- 3-fraction spine SBRT is a safe re-irradiation option with an 85% 2-year local control rate.
- PTV DMin and GI histology are key factors influencing LF risk.
- Further research is needed to refine optimal dose-fractionation for spine SBRT re-irradiation.
