title: Clinical outcomes after reirradiation of paraspinal tumors.
abstract: OBJECTIVE
  We present our experience with reirradiation of locally recurrent paraspinal tumors using image-guided intensity modulated radiotherapy (IG-IMRT).
  
  
  METHODS
  We performed a retrospective review of 37 patients who were reirradiated using IG-IMRT for recurrent paraspinal tumors between 2000 and 2005. We evaluated radiation dose to the spinal cord or cauda equina in first and second radiation treatments, time to first recurrence, and clinical outcomes after reirradiation including second recurrence, survival, pain, functional status, and toxicity.
  
  
  RESULTS
  Median time to local failure after first radiation was 13 months. All patients underwent salvage reirradiation, postoperatively or with IG-IMRT alone. Median radiation dose to the planning target volume (PTV) was 2000 cGy; median spinal cord or cauda equina dose was 990 cGy. Median cumulative spinal cord or cauda equina dose was 4198 cGy. Local control probability at a median follow-up of 8 months was 60%; median interval to second failure was 13 months. Survival probability at a median follow up of 12 months was 72%; median survival was 18 months. Thirty-four patients (91%) reported stable or improved pain after second radiation, and 26 (70%) had a stable or improved functional status. Mild acute toxicity occurred in 3 patients (8%). No long-term toxicity has been identified.
  
  
  CONCLUSIONS
  Reirradiation using IG-IMRT is safe and achieves a meaningful interval of local control with improved symptoms. Further studies with more patients and longer follow up are needed to evaluate toxicity, predictors of failure, and timing of radiation after surgical salvage.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Jean L
authors.initials: JL
authors.lastname: Wright
authors.forename: D Michael
authors.initials: DM
authors.lastname: Lovelock
authors.forename: Mark H
authors.initials: MH
authors.lastname: Bilsky
authors.forename: Sean
authors.initials: S
authors.lastname: Toner
authors.forename: Joan
authors.initials: J
authors.lastname: Zatcky
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D010166:Palliative Care; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000532:radiotherapy*; D016019:Survival Analysis; D016896:Treatment Outcome