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- Title
SBRT of Spinal Metastases Using a Simultaneous Integrated Boost Concept in Oligometastatic Cancer Patients Is Safe and Effective.
- Authors
Waltenberger, Maria; Strick, Christian; Vogel, Marco M. E.; Diehl, Christian; Combs, Stephanie E.
- Abstract
Simple Summary: Metastases-directed stereotactic body radiotherapy (SBRT) is increasingly used in the context of oligometastatic disease, as fist prospective data show improved survival with additional ablative radiotherapy in subgroups of oligometastatic patients. The spine is a common site for metastases, and different treatment regimens are used for spinal SBRT. Vertebral compression fracture (VCF) is a main safety concern. Our single-center retrospective analysis of 62 consecutive oligometastatic cancer patients with 71 spinal metastases provides first evidence for spinal SBRT utilizing a simultaneous integrated boost to the macroscopic lesion in a larger patient cohort and demonstrates the safety and effectivity of this treatment regimen: No ≥ grade III acute and one grade III late toxicity (VCF) occurred, and estimated local control rates were excellent and durable with 98.6% and 96.4% at one and two years. Regarding survival, patients with prostate cancer, secondary oligometastatic disease and good performance status might especially benefit from this treatment approach. (1) Purpose: To assess the safety and effectivity of stereotactic body radiotherapy (SBRT) on spinal metastases utilizing a simultaneous integrated boost (SIB) concept in oligometastatic cancer patients. (2) Methods: 62 consecutive patients with 71 spinal metastases received SIB–SBRT between 01/2013 and 09/2022 at our institution. We retrospectively analyzed toxicity, local tumor control (LC), and progression-free (PFS) and overall survival (OS) following SIB–SBRT and assessed possible influencing factors (Kaplan–Meier estimator, log-rank test and Cox proportional-hazards model). (3) Results: SIB–SBRT was delivered in five fractions, mostly with 25/40 Gy (n = 43; 60.56%) and 25/35 Gy (n = 19, 26.76%). Estimated rates of freedom from VCF were 96.1/90.4% at one/two years. VCF development was significantly associated with osteoporosis (p < 0.001). No ≥ grade III acute and one grade III late toxicity (VCF) were observed. Estimated LC rates at one/two years were 98.6/96.4%, and histology was significantly associated with local treatment failure (p = 0.039). Median PFS/OS was 10 months (95% CI 6.01–13.99)/not reached. Development of metastases ≥ one year after initial diagnosis and Karnofsky Performance Score ≥ 90% were predictors for superior PFS (p = 0.038) and OS (p = 0.012), respectively. (4) Conclusion: Spinal SIB–SBRT yields low toxicity and excellent LC. It may be utilized in selected oligometastatic patients to improve prognosis. To the best of our knowledge, we provide the first clinical data on the toxicity and effectivity of SIB–SBRT in spinal metastases in a larger patient cohort.
- Subjects
CONFIDENCE intervals; LOG-rank test; METASTASIS; RETROSPECTIVE studies; TREATMENT effectiveness; CANCER patients; OSTEOPOROSIS; TREATMENT failure; RADIATION doses; RESEARCH funding; KAPLAN-Meier estimator; DESCRIPTIVE statistics; KARNOFSKY Performance Status; RADIOSURGERY; PROGRESSION-free survival; HISTOLOGY; SPINAL tumors; PATIENT safety; OVERALL survival; PROPORTIONAL hazards models
- Publication
Cancers, 2023, Vol 15, Issue 24, p5813
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers15245813