title: Technique and early clinical outcomes for spinal and paraspinal tumours treated with stereotactic body radiotherapy.
abstract: We report technique and early clinical results of stereotactic body radiotherapy (SBRT) from Princess Alexandra Hospital. SBRT involves the precise delivery of highly conformal and image-guided external beam radiotherapy with high doses per fraction. It is increasingly being applied in management of spinal tumours. Thirty-six courses of spine SBRT in 34 patients were delivered between May 2010 and December 2013. Mean patient age was 58 years. Treatment was predominantly for metastatic disease, applied in de novo (n=22), retreatment (n=14) and postoperative (n=8) settings. Prescribed doses included 18-30 Gy in 1-5 fractions. SBRT technique evolved during the study period, resulting in a relative dose escalation. No severe acute toxicities were observed. At median follow-up of 7.4 months (range: 1.7-22.2), no late radiation myelopathy was observed. Risk of new/worsening vertebral compression fractures was 22% (n=8) and was significantly associated with increasing Spinal Instability Neoplastic Scores (p=0.0002). In-field control was 86% with relapse occurring at a median interval of 2.8 months (range: 1.9-4.7). Thirteen patients (36%) died and median overall survival has not been reached. SBRT is an evolving technology with promising early efficacy and safety results. The outcomes of this series are comparable with international literature, and await longer follow-up.
authors.affiliation: Radiation Oncology Queensland, Southport, QLD, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
authors.forename: Renee
authors.initials: R
authors.lastname: Finnigan
authors.affiliation: University of Queensland School of Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia.
authors.forename: Bryan
authors.initials: B
authors.lastname: Burmeister
authors.affiliation: Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
authors.forename: Tamara
authors.initials: T
authors.lastname: Barry
authors.affiliation: Centre for Experimental Haematology, University of Queensland School of Medicine, Translational Research Institute, Woolloongabba, QLD, Australia.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Jones
authors.affiliation: Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
authors.forename: Josh
authors.initials: J
authors.lastname: Boyd
authors.affiliation: University of Queensland School of Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Pullar
authors.affiliation: Department of Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Williams
authors.affiliation: University of Queensland School of Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia. Electronic address: matthew.foote@health.qld.gov.au.
authors.forename: Matthew
authors.initials: M
authors.lastname: Foote
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D050815:Fractures, Compression / Q000453:epidemiology; D006801:Humans; D007593:Joint Instability / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D016103:Spinal Fractures / Q000453:epidemiology; D013125:Spinal Neoplasms / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Paraspinal tumour; Radiosurgery; Spinal tumour; Stereotactic