title: Vertebral metastases reirradiation with volumetric-modulated arc radiotherapy.
abstract: OBJECTIVE
  To assess the feasibility, acute toxicity, clinical improvement, local control and survival for spinal metastatic patients re-irradiated using volumetric-modulated-arc-radiotherapy (VMAT).
  
  
  METHODS
  Between February 2009 and November 2010, 31 patients were treated. Surgery was performed in six before re-irradiation. The clinical target volume (CTV) was defined as the whole vertebrae with recurrence excluding the central section of spinal canal. Planning target volume was defined as CTV+0-5mm in the three directions. Dose was prescribed in order to have biological equivalent dose to the spinal cord from the two courses lower than 120 Gy(2) to 1 cc of the volume. Clinical improvement, toxicity and recurrence were evaluated. All patients had back pain before treatment and 15 (48%) neurological deficit.
  
  
  RESULTS
  Clinical remission of pain was obtained in 29 patients (93%). Neurological improvement was observed in 73% of patients. No acute or late toxicities were recorded. No recurrence occurred. Median survival was 10 months (range 6-24). At the last follow-up 19 patients (61%) were alive and 12 (39%) dead from systemic disease progression. The 1 and 2 year survival were 55% and 35%, respectively.
  
  
  CONCLUSIONS
  In patients with spinal metastases recurrence re-irradiation with VMAT is feasible and provides clinical benefit in most patients.
authors.affiliation: Radiation Oncology Department, IRCCS Istituto Clinico Humanitas, Rozzano, Italy. piera.navarria@humanitas.it
authors.forename: Pierina
authors.initials: P
authors.lastname: Navarria
authors.forename: Pietro
authors.initials: P
authors.lastname: Mancosu
authors.forename: Filippo
authors.initials: F
authors.lastname: Alongi
authors.forename: Sara
authors.initials: S
authors.lastname: Pentimalli
authors.forename: Angelo
authors.initials: A
authors.lastname: Tozzi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Reggiori
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ascolese
authors.forename: Stefano
authors.initials: S
authors.lastname: Arcangeli
authors.forename: Francesca
authors.initials: F
authors.lastname: Lobefalo
authors.forename: Riccardo Rodriguez Y
authors.initials: RR
authors.lastname: Baena
authors.forename: Simona
authors.initials: S
authors.lastname: Castiglioni
authors.forename: Federico
authors.initials: F
authors.lastname: Pessina
authors.forename: Flavio
authors.initials: F
authors.lastname: Tancioni
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
authors.forename: Antonella
authors.initials: A
authors.lastname: Fogliata
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods*; D013125:Spinal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D047368:Tumor Burden