title: Stereotactic body radiotherapy is effective salvage therapy for patients with prior radiation of spinal metastases.
abstract: OBJECTIVE
  To provide actuarial outcomes and dosimetric data for spinal/paraspinal metastases, with and without prior radiation, treated with stereotactic body radiotherapy (SBRT).
  
  
  METHODS
  A total of 39 consecutive patients (60 metastases) were treated with SBRT between April 2003 and August 2006 and retrospectively reviewed. In all, 23 of 60 tumors had no previous radiation (unirradiated) and 37/60 tumors had previous irradiation (reirradiated). Of 37 reirradiated tumors, 31 were treated for "salvage" given image-based tumor progression. Local failure was defined as progression by imaging and/or clinically.
  
  
  RESULTS
  At last follow-up, 19 patients were deceased. Median patient survival time measured was 21 months (95% CI = 8-27 months), and the 2-year survival probability was 45%. The median total dose prescribed was 24 Gy in three fractions prescribed to the 67% and 60% isodose for the unirradiated and reirradiated cohorts, respectively. The median tumor follow-up for the unirradiated and reirradiated group was 9 months (range, 1-26) and 7 months (range, 1-48) respectively. Eight of 60 tumors have progressed, and the 1- and 2-year progression-free probability (PFP) was 85% and 69%, respectively. For the salvage group the 1 year PFP was 96%. There was no significant difference in overall survival or PFP between the salvage reirradiated vs. all other tumors treated (p = 0.08 and p = 0.31, respectively). In six of eight failures the minimum distance from the tumor to the thecal sac was <or=1 mm. Of 60 tumors treated, 39 have >or=6 months follow-up and no radiation-induced myelopathy or radiculopathy has occurred.
  
  
  CONCLUSIONS
  Spine SBRT has shown preliminary efficacy and safety in patients with image-based progression of previously irradiated metastases.
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA. Arjun.sahgal@rmp.uhn.on.ca
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.forename: Christopher
authors.initials: C
authors.lastname: Ames
authors.forename: Dean
authors.initials: D
authors.lastname: Chou
authors.forename: Lijun
authors.initials: L
authors.lastname: Ma
authors.forename: Kim
authors.initials: K
authors.lastname: Huang
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chin
authors.forename: Vivan
authors.initials: V
authors.lastname: Weinberg
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chuang
authors.forename: Phillip
authors.initials: P
authors.lastname: Weinstein
authors.forename: David A
authors.initials: DA
authors.lastname: Larson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018450:Disease Progression; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods* / Q000401:mortality; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D013116:Spinal Cord / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D047368:Tumor Burden; D055815:Young Adult