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Stereotactic radiosurgery for the treatment of bulky spine metastases

  • Clinical Study
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Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Introduction

Stereotactic radiosurgery (SRS) has shown durable local control for the treatment of metastatic diseasespinal metastases. Multilevel disease or epidural or paraspinal involvement present challenges to achieving local control, and this study aims to analyze treatment outcomes for such lesions.

Methods

Patients treated at a single institution with SRS to the spine from 2010–2018 were retrospectively reviewed. Inclusion criteria required clinical follow-up with either a pain assessment or imaging study. Bulky spine metastasis was defined as consisting of multilevel disease or epidural or paraspinal tumor involvement.

Results

54 patients treated for 62 lesions met inclusion criteria. 42 treatments included at least two vertebrae, and 21 and 31 had paraspinal and epidural involvement, respectively. Treatment regimens had a median 24 Gy in 3 fractions to a volume of 37.75 cm3. Median follow-up was 14.36 months, with 5 instances (8%) of local failure. Median overall survival was 13.32 months. Pain improvement was achieved in 47 treatments (76%), and pain improved with treatment (p < 0.0001). Severe pain (HR = 3.08, p = 0.05), additional bone metastases (HR = 4.82, p = 0.05), and paraspinal involvement (HR = 3.93, p < 0.005) were predictive for worse overall survival. Kaplan–Meier analysis demonstrated that prior chemotherapy (p = 0.03) and additional bone metastases (p = 0.02) were predictive of worse overall survival. Grade < 3 toxicity was observed in 19 cases; no grade ≥ 3 side effects were observed.

Conclusions

SRS can effectively treat bulky metastases to the spine, resulting in improvement of pain with minimal toxicity. Severe pain independently predicts for worse overall survival, indicating that treatment prior to worsening of pain is strongly recommended

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

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Authors and Affiliations

  1. University of Virginia / Riverside, Radiosurgery Center, Newport News, VA, USA

    Roman O. Kowalchuk, Michael R. Waters, K. Martin Richardson, Kelly M. Spencer, William H. McAllister & C. R. Kersh

  2. Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA

    James M. Larner

  3. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA

    Jason P. Sheehan

Authors
  1. Roman O. Kowalchuk
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  2. Michael R. Waters
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  3. K. Martin Richardson
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  4. Kelly M. Spencer
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  5. James M. Larner
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  6. Jason P. Sheehan
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  7. William H. McAllister
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  8. C. R. Kersh
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Contributions

Study conception and design was primarily conducted by RO.K, with the assistance of C.R.K. Data preparation, collection, and analysis were performed by RO.K. The first draft of the manuscript was written by RO.K. All authors contributed to the editing of the final manuscript.

Corresponding author

Correspondence to Roman O. Kowalchuk.

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Conflict of interest

The wife of Dr. Kowalchuk is a senior technical product manager at GE Healthcare.

Ethical approval

This study was exempt by the institutional review board and was conducted in accordance with their tenets for a retrospective study.

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Supplementary file1 (TIF 31 kb)

Supplemental Fig. 1 Predictive factors for overall survival are demonstrated, with severe pain and additional bone metastases demonstrating statistical significance (p=0.05) and prior palliative chemotherapy trending towards significance (p=0.06)

Supplementary file2 (DOCX 15 kb)

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Kowalchuk, R.O., Waters, M.R., Richardson, K.M. et al. Stereotactic radiosurgery for the treatment of bulky spine metastases. J Neurooncol 148, 381–388 (2020). https://doi.org/10.1007/s11060-020-03534-4

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  • DOI: https://doi.org/10.1007/s11060-020-03534-4

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