title: Clinical outcome of dose-escalated image-guided radiotherapy for spinal metastases.
abstract: OBJECTIVE
  To evaluate the outcomes after dose-escalated radiotherapy (RT) for spinal metastases and paraspinal tumors.
  
  
  METHODS
  A total of 14 patients, 12 with spinal metastases and a long life expectancy and 2 with paraspinal tumors, were treated for 16 lesions with intensity-modulated, image-guided RT. A median biologic effective dose of 74 Gy(10) (range, 55-86) in a median of 20 fractions (range, 3-34) was prescribed to the target volume. The spinal canal was treated to 40 Gy in 20 fractions using a second intensity-modulated RT dose level in the case of epidural involvement.
  
  
  RESULTS
  After median follow-up of 17 months, one local recurrence was observed, for an actuarial local control rate of 88% after 2 years. Local control was associated with rapid and long-term pain relief. Of 11 patients treated for a solitary spinal metastasis, 6 developed systemic disease progression. The actuarial overall survival rate for metastatic patients was 85% and 63% after 1 and 2 years, respectively. Acute Grade 2-3 skin toxicity was seen in 2 patients with no late toxicity greater than Grade 2. No radiation-induced myelopathy was observed.
  
  
  CONCLUSIONS
  Dose-escalated irradiation of spinal metastases was safe and resulted in excellent local control. Oligometastatic patients with a long life expectancy and epidural involvement are considered to benefit the most from fractionated RT.
authors.affiliation: Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Strasse 11, Wuerzburg, Germany. guckenberger_m@klinik.uni-wuerzburg.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Guckenberger
authors.forename: Joachim
authors.initials: J
authors.lastname: Goebel
authors.forename: Juergen
authors.initials: J
authors.lastname: Wilbert
authors.forename: Kurt
authors.initials: K
authors.lastname: Baier
authors.forename: Anne
authors.initials: A
authors.lastname: Richter
authors.forename: Reinhart A
authors.initials: RA
authors.lastname: Sweeney
authors.forename: Klaus
authors.initials: K
authors.lastname: Bratengeier
authors.forename: Michael
authors.initials: M
authors.lastname: Flentje
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D054893:Cone-Beam Computed Tomography; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D015996:Survival Rate; D016896:Treatment Outcome