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01-06-2020 | Metastasis | Clinical Study

Stereotactic radiosurgery for the treatment of bulky spine metastases

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

Published in: Journal of Neuro-Oncology | Issue 2/2020

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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Title: Stereotactic radiosurgery for the treatment of bulky spine metastases
Authors: Roman O. Kowalchuk
Michael R. Waters
K. Martin Richardson
Kelly M. Spencer
James M. Larner
Jason P. Sheehan
William H. McAllister
C. R. Kersh
Publication date: 01-06-2020
Publisher: Springer US
Keyword: Metastasis
Published in: Journal of Neuro-Oncology / Issue 2/2020
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-020-03534-4

At a glance: The STEP trials

Springer Medicine

Stereotactic radiosurgery for the treatment of bulky spine metastases

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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