Stereotactic body radiation therapy for spinal metastases: A novel local control stratification by spinal region

Roman O. Kowalchuk, Michael R. Waters, K. Martin Richardson, Kelly Spencer, James M. Larner, William H. McAllister, Jason P. Sheehan, Charles R. Kersh

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

OBJECTIVE This study evaluated a large cohort of patients treated with stereotactic body radiation therapy for spinal metastases and investigated predictive factors for local control, local progression-free survival (LPFS), overall survival, and pain response between the different spinal regions. METHODS The study was undertaken via retrospective review at a single institution. Patients with a tumor metastatic to the spine were included, while patients with benign tumors or primary spinal cord cancers were excluded. Statistical analysis involved univariate analysis, Cox proportional hazards analysis, the Kaplan-Meier method, and machine learning techniques (decision-tree analysis). RESULTS A total of 165 patients with 190 distinct lesions met all inclusion criteria for the study. Lesions were distributed throughout the cervical (19%), thoracic (43%), lumbar (19%), and sacral (18%) spines. The most common treatment regimen was 24 Gy in 3 fractions (44%). Via the Kaplan-Meier method, the 24-month local control was 80%. Sacral spine lesions demonstrated decreased local control (p = 0.01) and LPFS (p < 0.005) compared with those of the thoracolumbar spine. The cervical spine cases had improved local control (p < 0.005) and LPFS (p < 0.005) compared with the sacral spine and trended toward improvement relative to the thoracolumbar spine. The 36-month local control rates for cervical, thoracolumbar, and sacral tumors were 86%, 73%, and 44%, respectively. Comparably, the 36-month LPFS rates for cervical, thoracolumbar, and sacral tumors were 85%, 67%, and 35%, respectively. A planning target volume (PTV) > 50 cm3 was also predictive of local failure (p = 0.04). Fewer cervical spine cases had disease with PTV > 50 cm3 than the thoracolumbar (p = 5.87 × 10−8) and sacral (p = 3.9 × 10−3) cases. Using decision-tree analysis, the highest-fidelity models for predicting pain-free status and local failure demonstrated the first splits as being cervical and sacral location, respectively. CONCLUSIONS This study presents a novel risk stratification for local failure and LPFS by spinal region. Patients with metastases to the sacral spine may have decreased local control due to increased PTV, especially with a PTV of > 50 cm3. Multidisciplinary care should be emphasized in these patients, and both surgical intervention and radiotherapy should be strongly considered.

Original languageEnglish
Pages (from-to)267-276
Number of pages10
JournalJournal of Neurosurgery: Spine
Volume34
Issue number2
DOIs
StatePublished - Feb 2021

Keywords

  • Local control
  • Metastasis
  • Oncology
  • SABR
  • SBRT
  • Stereotactic ablative radiosurgery
  • Stereotactic body radiation therapy

Fingerprint

Dive into the research topics of 'Stereotactic body radiation therapy for spinal metastases: A novel local control stratification by spinal region'. Together they form a unique fingerprint.

Cite this