title: The use of spine stereotactic radiosurgery for oligometastatic disease.
abstract: OBJECTIVE The authors investigated the outcomes following spine stereotactic radiosurgery (SSRS) for patients with oligometastatic disease of the spine. METHODS The study was a secondary analysis of 38 of 209 patients enrolled in 2 separate institutional Phase I/II prospective protocols and treated with SSRS between 2002 and 2011. Of these 38 patients, 33 (87%) were treated for a solitary spine metastasis, with no other history of metastatic disease. SSRS was prescribed to 24 Gy in 1 fraction (8%), 18 Gy in 1 fraction (18%), 16 Gy in 1 fraction (11%), 27 Gy in 3 fractions (53%), 30 Gy in 5 fractions (8%), or 20 Gy in 5 fractions (3%). Seventeen patients (45%) received prior conventional external beam radiation therapy. RESULTS The median overall survival (OS) was 75.7 months, and the 2- and 5-year OS rates were 84% and 60%, respectively. In multivariate analysis, patients who had prior spine surgery and a better Karnofsky Performance Scale score had an improved OS (HR 0.16, 95% CI 0.05-0.52, p < 0.01, and HR 0.33, 95% CI 0.13%-0.84%, p = 0.02, respectively), and those who had undergone prior radiation therapy had a worse OS (HR 3.6, 95% CI 1.2%-10%, p = 0.02). The 1-, 2-, and 5-year local progression-free survival rates were 85%, 82%, and 78%, respectively. The median time to systemic therapy modification was 41 months. Two patients (5%) experienced late Grade 3-4 toxicity. CONCLUSIONS Patients with oligometastatic disease of the spine treated with SSRS can experience long-term survival and a long time before needing a modification in systemic therapy. In addition, SSRS leads to excellent local control and minimal late toxicity.
authors.affiliation: Departments of 1 Radiation Oncology.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Ho
authors.affiliation: Departments of 1 Radiation Oncology.
authors.forename: Chad
authors.initials: C
authors.lastname: Tang
authors.affiliation: Departments of 1 Radiation Oncology.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Deegan
authors.affiliation: Departments of 1 Radiation Oncology.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Allen
authors.affiliation: Genitourinary Medical Oncology.
authors.forename: Eric
authors.initials: E
authors.lastname: Jonasch
authors.affiliation: Diagnostic Radiology.
authors.forename: Behrang
authors.initials: B
authors.lastname: Amini
authors.affiliation: Radiation Physics, and.
authors.forename: Xin A
authors.initials: XA
authors.lastname: Wang
authors.affiliation: Departments of 1 Radiation Oncology.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Claudio E
authors.initials: CE
authors.lastname: Tatsui
authors.affiliation: Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Rhines
authors.affiliation: Departments of 1 Radiation Oncology.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Brown
authors.affiliation: Departments of 1 Radiation Oncology.
authors.forename: Amol J
authors.initials: AJ
authors.lastname: Ghia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008875:Middle Aged; D015999:Multivariate Analysis; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D055815:Young Adult
keywords: CI = confidence interval; CTV = clinical treatment volume; DFS = disease-free survival; Dmax = dose maximum; Dmin = dose minimum; EBRT = external beam radiation therapy; GI = gastrointestinal; GTV = gross tumor volume; HR = hazard ratio; KPS = Karnofsky Performance Scale; OS = overall survival; SSRS = spine stereotactic radiosurgery; STMFS = systemic therapy modification-free survival; oligometastic disease; oncology; radiosurgery; spine metastases