title: High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions.
abstract: OBJECTIVE
  To report tumor control and toxicity for patients treated with image-guided intensity-modulated radiotherapy (RT) for spinal metastases with high-dose single-fraction RT.
  
  
  METHODS
  A total of 103 consecutive spinal metastases in 93 patients without high-grade epidural spinal cord compression were treated with image-guided intensity-modulated RT to doses of 18-24 Gy (median, 24 Gy) in a single fraction between 2003 and 2006. The spinal cord dose was limited to a 14-Gy maximal dose. The patients were prospectively examined every 3-4 months with clinical assessment and cross-sectional imaging.
  
  
  RESULTS
  The overall actuarial local control rate was 90% (local failure developed in 7 patients) at a median follow-up of 15 months (range, 2-45 months). The median time to local failure was 9 months (range, 2-15 months) from the time of treatment. Of the 93 patients, 37 died. The median overall survival was 15 months. In all cases, death was from progression of systemic disease and not local failure. The histologic type was not a statistically significant predictor of survival or local control. The radiation dose was a significant predictor of local control (p = 0.03). All patients without local failure also reported durable symptom palliation. Acute toxicity was mild (Grade 1-2). No case of radiculopathy or myelopathy has developed.
  
  
  CONCLUSIONS
  High-dose, single-fraction image-guided intensity-modulated RT is a noninvasive intervention that appears to be safe and very effective palliation for patients with spinal metastases, with minimal negative effects on quality of life and a high probability of tumor control.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. yamadaj@mskcc.org
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamada
authors.forename: Mark H
authors.initials: MH
authors.lastname: Bilsky
authors.forename: D Michael
authors.initials: DM
authors.lastname: Lovelock
authors.forename: Ennapadam S
authors.initials: ES
authors.lastname: Venkatraman
authors.forename: Sean
authors.initials: S
authors.lastname: Toner
authors.forename: Jared
authors.initials: J
authors.lastname: Johnson
authors.forename: Joan
authors.initials: J
authors.lastname: Zatcky
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.forename: Zvi
authors.initials: Z
authors.lastname: Fuks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054893:Cone-Beam Computed Tomography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D016879:Salvage Therapy; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000528:radiation effects; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D015996:Survival Rate; D013997:Time Factors