University Hospital Zurich / Matthias Guckenberger*
Abstract
BACKGROUND:
The objective of this study was to prospectively evaluate dose-intensified hypofractionated stereotactic body radiation therapy (SBRT) in patients with painful spinal metastases in a multicenter, single-arm, phase 2 study.
METHODS:
Patients with 2 or fewer distinct, noncontiguous, painful, mechanically stable, unirradiated spinal metastases from a solid tumor with a Karnofsky performance status ≥ 60 were eligible. Patients with a long (Mizumoto score ≤ 4) or intermediate overall survival expectancy (Mizumoto score = 5-9) received 48.5 Gy in 10 fractions or 35 Gy in 5 fractions, respectively, with SBRT. The primary outcome was the overall (complete and partial) pain response as measured with international consensus guidelines 3 months after SBRT.
RESULTS:
There were 57 patients enrolled between 2012 and 2015, and 54 of these patients with 60 painful vertebral metastases were analyzed. The 3-month pain response was evaluated in 42 patients (47 lesions). An overall pain response was observed in 41 lesions (87%), and the pain response remained stable for at least 12 months. The mean maximum pain scores on a visual analogue scale significantly improved from the baseline of 6.1 (standard deviation, 2.5) to 2.0 (standard deviation, 2.3) 3 months after treatment (P < .001). The 5-level EuroQol 5-Dimension Questionnaire quality-of-life (QOL) dimensions (self-reported mobility, usual activities, and pain/discomfort) significantly improved from the baseline to 3 months after treatment. The 12-month overall survival and local control rates were 61.4% (95% confidence interval [CI], 48%-74.8%) and 85.9% (95% CI, 76.7%-95%), respectively. Grade 3 toxicity was limited to acute pain in 1 patient (2%). No patient experienced radiation-induced myelopathy. Six patients (11%) developed progressive vertebral compression fractures (VCFs), and 8 patients (15%) developed new VCFs.
CONCLUSIONS:
Dose-intensified SBRT achieved durable local metastasis control and resulted in pronounced and long-term pain responses and improved QOL.
Author information
Guckenberger M1, Sweeney RA2, Hawkins M3, Belderbos J4, Andratschke N1, Ahmed M5, Madani I1, Mantel F6, Steigerwald S6, Flentje M6.
1
Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
2
Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany.
3
Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, United Kingdom.
4
Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
5
Department of Radiotherapy, Royal Marsden NHS Foundation Trust/Institute of Cancer Research, Sutton, United Kingdom.
6
Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany.
편집위원
Spine metastases를 치료할 때, spinal cord에 가까이 혹은 맞닿아 있는 경우 target delineation 및 dose prescription 할 때 tumor에 초점을 맞추면 neurotoxicity risk가 우려되고, spinal cord saving에 초점을 맞추면 marginal failure risk가 있는데, SIB technique을 이용해서 tumor와 spine cord 부위를 다르게 처방할 때 기존 SBRT 연구결과들과 비교할만한 LCR와 낮은 toxicity를 보고한 본 연구는 임상에서 쉽게 적용할만한 참고문헌으로서 추천된다.
2018-06-21 10:44:46