Stereotactic body radiotherapy reirradiation for recurrent epidural spinal metastases.
OBJECTIVE
When patients show progression after conventional fractionated radiation for spine metastasis, further radiation and surgery may not be options. Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use of SBRT for 60 consecutive patients (81 lesions) who had radiological progressive spine metastasis with epidural involvement after previous radiation for spine metastasis.


METHODS
SBRT was used with fiducial and vertebral anatomy-based targeting. The radiation dose was prescribed based on the extent of spinal canal involvement; the dose was 8 Gy×3=24 Gy when the tumor did not touch the spinal cord and 5 to 6 Gyx5=25 to 30 Gy when the tumor abutted the cord. The cord surface received up to the prescription dose with no hot spots in the cord.


RESULTS
The median overall survival was 11 months, and the median progression-free survival was 9 months. Overall, 93% of patients had stable or improved disease while 7% of patients showed disease progression; 65% of patients had pain relief. There was no significant toxicity other than fatigue.


CONCLUSIONS
SBRT is feasible and appears to be an effective treatment modality for reirradiation after conventional palliative radiation fails for spine metastasis patients.
Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. amahadev@bidmc.harvard.edu
Anand
A
Mahadevan
Scott
S
Floyd
Eric
E
Wong
Suriya
S
Jeyapalan
Michael
M
Groff
Ekkehard
E
Kasper
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D013812:Therapeutics / Q000379:methods