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  • [Cancer.] Dose-intensified hypofractionated stereotactic body radiation therapy for painful spinal metastases: Results of a phase 2 study.

    University Hospital Zurich / Matthias Guckenberger*

  • 출처
    Cancer.
  • 등재일
    2018 May 1
  • 저널이슈번호
    124(9):2001-2009. doi: 10.1002/cncr.31294. Epub 2018 Mar 2.
  • 내용

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    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.

  • 키워드
    local control; overall survival; pain; pain response; quality of life; spinal metastasis; stereotactic body radiation therapy
  • 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

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