Volumetric Intensity-Modulated Arc Stereotactic Radiosurgery Boost in Oligometastatic Patients with Spine Metastases: a Dose-escalation Study |
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| Affiliation: | 1. Radiation Oncology Unit, Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Campobasso, Italy;2. Radiology Institute, Università Cattolica del Sacro Cuore, Rome, Italy;3. Medical Physics Unit, Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Campobasso, Italy;4. Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Rome, Italy;5. Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy;1. Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia;2. Department of Surgical Oncology, University Medical Centre Groningen, Groningen, the Netherlands;3. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia;4. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia;5. GenesisCare, Radiation Oncology, Mater Sydney Hospital, Sydney, NSW, Australia;1. Beijing Jishuitan Hospital, Beijing, China;2. Nanjing Personal Oncology Biological Technology Co. Ltd, Nanjing, China;3. Changzheng Hospital, Shanghai, China;4. The Sixth People''s Hospital, Shanghai Jiao Tong University, Shanghai, China;5. Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China;7. The First Affiliated Hospital of Nanjing Medical University, Nanjing, China;11. Zhongshan Hospital, Fudan University, Shanghai, China;1. Department of Hematology, The First People''s Hospital of Yunnan Province, Yunnan, China;2. The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China;1. Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands;2. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands;1. UK SABR Consortium Committee, UK;2. Department of Clinical Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK;3. Clinical Oncology Quality Improvement and Audit Committee, Royal College of Radiologists, London, UK;4. Radiotherapy Physics, Barts Health NHS Trust, London, UK;5. National Radiotherapy Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, UK;7. Lung Unit, Royal Marsden NHS Foundation Trust, London, UK;1. Cardiff University, Cardiff, UK;2. The Clatterbridge Cancer Centre, Liverpool, UK |
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| Abstract: | AimsTo report the final results of a dose-escalation study of volumetric intensity-modulated arc stereotactic radiosurgery (VMAT-SRS) boost after three-dimensional conformal radiation therapy in patients with spine metastases.Materials and methodsOligometastatic cancer patients bearing up to five synchronous metastases (visceral or bone, including vertebral ones) and candidates for surgery or radiosurgery were considered for inclusion. 25 Gy was delivered in 10 daily fractions (2 weeks) to the metastatic lesion, affected vertebrae and adjacent ones (one cranial and one caudal vertebra). Sequentially, the dose to spinal metastases was progressively increased (8 Gy, 10 Gy, 12 Gy) in the patient cohorts. Dose-limiting toxicities were defined as any treatment-related non-hematologic acute adverse effects rated as grade ≥3 or any acute haematological toxicity rated as ≥ 4 by the Radiation Therapy Oncology Group scale.ResultsFifty-two lesions accounting for 40 consecutive patients (male/female: 29/11; median age: 71 years; range 40–85) were treated from April 2011 to September 2020. Most patients had a primary prostate (65.0%) or breast cancer (22.5%). Thirty-two patients received 8 Gy VMAT-SRS boost (total BED α/β10: 45.6 Gy), 14 patients received 10 Gy (total BED α/β10: 51.2 Gy) and six patients received 12 Gy (total BED α/β10: 57.6 Gy). The median follow-up time was over 70 months (range 2–240 months). No acute toxicities > grade 2 and no late toxicities > grade 1 were recorded. The overall response rate based on computed tomography/positron emission tomography–computed tomography/magnetic resonance was 78.8%. The 24-month actuarial local control, distant metastases-free survival and overall survival rates were 88.5%, 27.1% and 90.3%, respectively.ConclusionA 12 Gy spine metastasis SRS boost following 25 Gy to the affected and adjacent vertebrae was feasible with an excellent local control rate and toxicity profile. |
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| Keywords: | Oligometastases spinal metastases vertebral compression fracture stereotactic body radiotherapy radiosurgery volumetric arc radiotherapy SRS"} {"#name":"keyword" "$":{"id":"pc_FWnoIEL1On"} "$$":[{"#name":"text" "_":"Radiosurgery SBRT"} {"#name":"keyword" "$":{"id":"pc_8MgNM0CGyu"} "$$":[{"#name":"text" "_":"Stereotactic body radiotherapy VMAT"} {"#name":"keyword" "$":{"id":"pc_KVyiZ8JYSi"} "$$":[{"#name":"text" "_":"Volumetric arc radiotherapy |
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