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Journal of Neuro-Oncology

, Volume 137, Issue 2, pp 289–293 | Cite as

Recursive partitioning analysis is predictive of overall survival for patients undergoing spine stereotactic radiosurgery

  • Ehsan H. Balagamwala
  • Jacob A. Miller
  • Chandana A. Reddy
  • Lilyana Angelov
  • John H. Suh
  • Muhammad B. Tariq
  • Erin S. Murphy
  • Kailin Yang
  • Toufik Djemil
  • Anthony Magnelli
  • Alireza M. Mohammadi
  • Sherry Soeder
  • Samuel T. ChaoEmail author
Clinical Study

Abstract

Spine stereotactic radiosurgery (SRS) offers excellent radiographic and pain control for patients with spine metastases. We created a prognostic index using recursive partitioning analysis (RPA) to allow better patient selection for spine SRS. Patients who underwent single-fraction spine SRS for spine metastases were included. Primary histologies were divided into favorable (breast/prostate), radioresistant (renal cell/sarcoma/melanoma) and other. Cox proportional hazards regression was done to identify factors associated with overall survival (OS). RPA was performed to identify factors to classify patients into distinct risk groups with respect to OS. A total of 444 patients were eligible. Median dose was 16 Gy (range 8–18) in 1 fraction and median follow-up was 11.7 months. At time of analysis, 103 (23.1%) patients were alive. Median OS was 12.9 months. RPA identified three distinct classes. Class 1 was defined as KPS > 70 with controlled systemic disease (n = 142); class 3 was defined as KPS ≤ 70 and age < 54 years or KPS ≤ 70 age ≥ 54 years and presence of visceral metastases (n = 95); all remaining patients comprise class 2 (n = 207). Median overall survival was 26.7 months for class 1, 13.4 months for class 2, and 4.5 months for class 3 (p < 0.01). Our analysis demonstrates that there is considerably variability in survival among patients undergoing spine SRS. We created an objective risk stratification via RPA for spine SRS. Given the safety and efficacy of spine SRS and good survival in class 1 and 2 patients, this RPA can help clinicians identify patients who may benefit from upfront spine SRS.

Keywords

Recursive partitioning analysis (RPA) Spine stereotactic radiosurgery Spine metastasis Overall survival 

Notes

Compliance with ethical standards

Conflict of interest

John H. Suh: Consultant, Varian Medical Systems. Samuel T. Chao: Speaker’s Bureau, Varian Medical Systems.

References

  1. 1.
    Finn MA, Vrionis FD, Schmidt MH (2007) Spinal radiosurgery for metastatic disease of the spine. Cancer Control J Moffitt Cancer Cent 14:405–411CrossRefGoogle Scholar
  2. 2.
    Chang BK, Timmerman RD (2007) Stereotactic body radiation therapy: a comprehensive review. Am J Clin Oncol 30:637–644.  https://doi.org/10.1097/COC.0b013e3180ca7cb1 CrossRefPubMedGoogle Scholar
  3. 3.
    Balagamwala EH, Cherian S, Angelov L et al (2012) Stereotactic body radiotherapy for the treatment of spinal metastases. J Radiat Oncol 1:255–265.  https://doi.org/10.1007/s13566-012-0047-6 CrossRefGoogle Scholar
  4. 4.
    Balagamwala EH, Angelov L, Koyfman SA et al (2012) Single-fraction stereotactic body radiotherapy for spinal metastases from renal cell carcinoma. J Neurosurg Spine 17:556–564.  https://doi.org/10.3171/2012.8.SPINE12303 CrossRefPubMedGoogle Scholar
  5. 5.
    Gerszten PC, Burton SA, Ozhasoglu C et al (2005) Stereotactic radiosurgery for spinal metastases from renal cell carcinoma. J Neurosurg Spine 3:288–295.  https://doi.org/10.3171/spi.2005.3.4.0288 CrossRefPubMedGoogle Scholar
  6. 6.
    Miller JA, Balagamwala EH, Angelov L et al (2016) Stereotactic radiosurgery for the treatment of primary and metastatic spinal sarcomas. Technol Cancer Res Treat.  https://doi.org/10.1177/1533034616643221 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Balagamwala EH, Chao ST, Suh JH (2012) Principles of radiobiology of stereotactic radiosurgery and clinical applications in the central nervous system. Technol Cancer Res Treat 11:3–13CrossRefGoogle Scholar
  8. 8.
    Chao ST, Koyfman SA, Woody N et al (2012) Recursive partitioning analysis index is predictive for overall survival in patients undergoing spine stereotactic body radiation therapy for spinal metastases. Int J Radiat Oncol Biol Phys 82:1738–1743.  https://doi.org/10.1016/j.ijrobp.2011.02.019 CrossRefPubMedGoogle Scholar
  9. 9.
    Kim H, Rajagopalan MS, Beriwal S et al (2015) Cost-effectiveness analysis of single fraction of stereotactic body radiation therapy compared with single fraction of external beam radiation therapy for palliation of vertebral bone metastases. Int J Radiat Oncol Biol Phys 91:556–563.  https://doi.org/10.1016/j.ijrobp.2014.10.055 CrossRefPubMedGoogle Scholar
  10. 10.
    Ho JC, Tang C, Deegan BJ et al (2016) The use of spine stereotactic radiosurgery for oligometastatic disease. J Neurosurg Spine 25:239–247.  https://doi.org/10.3171/2016.1.SPINE151166 CrossRefPubMedGoogle Scholar
  11. 11.
    Gerszten PC, Burton SA, Ozhasoglu C, Welch WC (2007) Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine 32:193–199.  https://doi.org/10.1097/01.brs.0000251863.76595.a2 CrossRefPubMedGoogle Scholar
  12. 12.
    Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751CrossRefGoogle Scholar
  13. 13.
    Sperduto PW, Berkey B, Gaspar LE et al (2008) A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys 70:510–514.  https://doi.org/10.1016/j.ijrobp.2007.06.074 CrossRefGoogle Scholar
  14. 14.
    Leithner A, Radl R, Gruber G et al (2008) Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J 17:1488–1495.  https://doi.org/10.1007/s00586-008-0763-1 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Bollen L, Wibmer C, Van der Linden YM et al (2016) Predictive value of six prognostic scoring systems for spinal bone metastases: an analysis based on 1379 patients. Spine 41:E155–E162.  https://doi.org/10.1097/BRS.0000000000001192 CrossRefPubMedGoogle Scholar
  16. 16.
    Papatheofanis FJ, Williams E, Chang SD (2009) Cost-utility analysis of the cyberknife system for metastatic spinal tumors. Neurosurgery 64:A73–A83.  https://doi.org/10.1227/01.NEU.0000341205.37067.DE CrossRefPubMedGoogle Scholar
  17. 17.
    Haley ML, Gerszten PC, Heron DE et al (2011) Efficacy and cost-effectiveness analysis of external beam and stereotactic body radiation therapy in the treatment of spine metastases: a matched-pair analysis. J Neurosurg Spine 14:537–542.  https://doi.org/10.3171/2010.12.SPINE10233 CrossRefPubMedGoogle Scholar
  18. 18.
    Miller JA, Balagamwala EH, Angelov L et al (2016) Quality of life outcomes following spine stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 96:S197.  https://doi.org/10.1016/j.ijrobp.2016.06.490 CrossRefGoogle Scholar
  19. 19.
    Balagamwala EH, Miller JA, Angelov L et al (2016) Clinical and quality of life implications of vertebral compression fracture following spine radiosurgery. Int J Radiat Oncol Biol Phys 96:E132.  https://doi.org/10.1016/j.ijrobp.2016.06.923 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ehsan H. Balagamwala
    • 1
  • Jacob A. Miller
    • 2
  • Chandana A. Reddy
    • 1
  • Lilyana Angelov
    • 3
    • 4
  • John H. Suh
    • 1
    • 4
    • 5
  • Muhammad B. Tariq
    • 2
  • Erin S. Murphy
    • 1
    • 4
    • 5
  • Kailin Yang
    • 2
  • Toufik Djemil
    • 6
  • Anthony Magnelli
    • 1
  • Alireza M. Mohammadi
    • 3
    • 4
  • Sherry Soeder
    • 1
  • Samuel T. Chao
    • 1
    • 4
    • 5
    Email author
  1. 1.Department of Radiation OncologyCleveland ClinicClevelandUSA
  2. 2.Cleveland Clinic Lerner College of MedicineClevelandUSA
  3. 3.Department of NeurosurgeryCleveland ClinicClevelandUSA
  4. 4.Rose Ella Burkhardt Brain Tumor and Neuro-Oncology CenterCleveland ClinicClevelandUSA
  5. 5.Taussig Cancer CenterCleveland ClinicClevelandUSA
  6. 6.Department of Radiation OncologyCleveland Clinic FloridaWestonUSA

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