Spine stereotactic body radiotherapy for renal cell cancer spinal metastases: analysis of outcomes and risk of vertebral compression fracture

被引:118
作者
Thibault, Isabelle [1 ]
Al-Omair, Ameen [1 ,2 ]
Masucci, Giuseppina Laura [2 ]
Masson-Cote, Laurence [2 ]
Lochray, Fiona [1 ]
Korol, Renee [1 ]
Cheng, Lu
Math, M. [3 ]
Xu, Wei
Yee, Albert [4 ]
Fehlings, Michael G. [5 ,6 ]
Bjarnason, Georg A. [7 ]
Sahgal, Arjun [1 ,2 ]
机构
[1] Univ Toronto, Dept Radiat Oncol, Sunnybrook Hlth Sci Ctr, Toronto, ON M4N 3M5, Canada
[2] Univ Toronto, Princess Margaret Canc Ctr, Dept Radiat Oncol, Toronto, ON M4N 3M5, Canada
[3] Univ Toronto, Princess Margaret Canc Ctr, Dept Biostat, Toronto, ON M4N 3M5, Canada
[4] Univ Toronto, Dept Orthopaed Surg, Sunnybrook Hlth Sci Ctr, Toronto, ON M4N 3M5, Canada
[5] Univ Toronto, Toronto Western Hosp, Div Neurosurg, Toronto, ON M4N 3M5, Canada
[6] Univ Toronto, Toronto Western Hosp, Spinal Program, Toronto, ON M4N 3M5, Canada
[7] Univ Toronto, Dept Med Oncol, Sunnybrook Hlth Sci Ctr, Toronto, ON M4N 3M5, Canada
关键词
renal cell cancer; spine metastases; oncology; stereotactic body radiotherapy; stereotactic radiosurgery; RADIATION-THERAPY; CLINICAL ARTICLE; RADIOSURGERY; CARCINOMA; CORD;
D O I
10.3171/2014.7.SPINE13895
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. The aim of this study was to evaluate local control (LC) and the risk of vertebral compression fracture (VCF) after stereotactic body radiotherapy (SBRT) in patients with renal cell cancer spinal metastases. Methods. Prospectively collected data on 71 spinal segments treated with SBRT in 37 patients were reviewed. The median follow-up was 12.3 months (range 1.2-55.4 months). The LC rate was assessed based on each spinal segment treated and overall survival (OS) according to each patient treated. Sixty of 71 segments (85%) were radiation naive, 11 of 71 (15%) were previously irradiated, and 10 of 71 (14%) were treated with postoperative SBRT. The median SBRT total dose and number of fractions were 24 Gy and 2, respectively. The VCF analysis also included evaluation of the Spinal Instability Neoplastic Score criteria. Results. The 1-year OS and LC rates were 64% and 83%, respectively. Multivariate analysis identified oligometastatic disease (13 of 37 patients) as a positive prognostic factor (p = 0.018) for OS. Of 61 non-postoperative spinal segments treated, 10 (16%) developed VCFs; 3 of 10 were de novo VCFs and 7 of 10 occurred as progression of an existing VCF. The 1-year VCF-free probability rate was 82%. Multivariate analysis identified single-fraction SBRT and baseline VCF as significant predictors of SBRT-induced VCF (p = 0.028 and p = 0.012, respectively). Conclusions. Spine SBRT yields high rates of local tumor control in patients with renal cell cancer. Baseline VCF and 18-24 Gy delivered in a single fraction were predictive of further collapse. Patients with oligometastatic disease may benefit most from such aggressive local therapy, given the prolonged survival observed.
引用
收藏
页码:711 / 718
页数:8
相关论文
共 22 条
[1]   Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy [J].
Al-Omair, Ameen ;
Masucci, Laura ;
Masson-Cote, Laurence ;
Campbell, Mikki ;
Atenafu, Eshetu G. ;
Parent, Amy ;
Letourneau, Daniel ;
Yu, Eugene ;
Rampersaud, Raja ;
Massicotte, Eric ;
Lewis, Stephen ;
Yee, Albert ;
Thibault, Isabelle ;
Fehlings, Michael G. ;
Sahgal, Arjun .
NEURO-ONCOLOGY, 2013, 15 (10) :1413-1419
[2]   Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation [J].
Al-Omair, Ameen ;
Smith, Roger ;
Kiehl, Tim-Rasmus ;
Lao, Louis ;
Yu, Eugene ;
Massicotte, Eric M. ;
Keith, Julia ;
Fehlings, Michael G. ;
Sahgal, Arjun .
JOURNAL OF NEUROSURGERY-SPINE, 2013, 18 (05) :430-435
[3]   Single-fraction stereotactic body radiotherapy for spinal metastases from renal cell carcinoma Clinical article [J].
Balagamwala, Ehsan H. ;
Angelov, Lilyana ;
Koyfman, Shlomo A. ;
Suh, John H. ;
Reddy, Chandana A. ;
Djemil, Toufik ;
Hunter, Grant K. ;
Xia, Ping ;
Chao, Samuel T. .
JOURNAL OF NEUROSURGERY-SPINE, 2012, 17 (06) :556-564
[4]   Negative impact of bone metastasis on outcome in clear-cell renal cell carcinoma treated with sunitinib [J].
Beuselinck, B. ;
Oudard, S. ;
Rixe, O. ;
Wolter, P. ;
Blesius, A. ;
Ayllon, J. ;
Elaidi, R. ;
Schoeffski, P. ;
Barrascout, E. ;
Morel, A. ;
Escudier, B. ;
Lang, H. ;
Zucman-Rossi, J. ;
Medioni, J. .
ANNALS OF ONCOLOGY, 2011, 22 (04) :794-800
[5]   Reliability analysis of the epidural spinal cord compression scale Clinical article [J].
Bilsky, Mark H. ;
Laufer, Ilya ;
Fourney, Daryl R. ;
Groff, Michael ;
Schmidt, Meic H. ;
Varga, Peter Paul ;
Vrionis, Frank D. ;
Yamada, Yoshiya ;
Gerszten, Peter C. ;
Kuklo, Timothy R. .
JOURNAL OF NEUROSURGERY-SPINE, 2010, 13 (03) :324-328
[6]   Pain Flare Is a Common Adverse Event in Steroid-Naive Patients After Spine Stereotactic Body Radiation Therapy: A Prospective Clinical Trial [J].
Chiang, Andrew ;
Zeng, Liang ;
Zhang, Liying ;
Lochray, Fiona ;
Korol, Renee ;
Loblaw, Andrew ;
Chow, Edward ;
Sahgal, Arjun .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2013, 86 (04) :638-642
[7]   STEREOTACTIC RADIOSURGERY FOR TREATMENT OF SPINAL METASTASES RECURRING IN CLOSE PROXIMITY TO PREVIOUSLY IRRADIATED SPINAL CORD [J].
Choi, Clara Y. H. ;
Adler, John R. ;
Gibbs, Iris C. ;
Chang, Steven D. ;
Jackson, Paul S. ;
Minn, A. Yuriko ;
Lieberson, Robert E. ;
Soltys, Scott G. .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2010, 78 (02) :499-506
[8]   International Spine Radiosurgery Consortium Consensus Guidelines for Target Volume Definition in Spinal Stereotactic Radiosurgery [J].
Cox, Brett W. ;
Spratt, Daniel E. ;
Lovelock, Michael ;
Bilsky, Mark H. ;
Lis, Eric ;
Ryu, Samuel ;
Sheehan, Jason ;
Gerszten, Peter C. ;
Chang, Eric ;
Gibbs, Iris ;
Soltys, Scott ;
Sahgal, Arjun ;
Deasy, Joe ;
Flickinger, John ;
Quader, Mubina ;
Mindea, Stefan ;
Yamada, Yoshiya .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2012, 83 (05) :E597-E605
[9]   Vertebral Compression Fracture (VCF) After Spine Stereotactic Body Radiation Therapy (SBRT): Analysis of Predictive Factors [J].
Cunha, Marcelo V. R. ;
Al-Omair, Ameen ;
Atenafu, Eshetu G. ;
Masucci, Giuseppina Laura ;
Letourneau, Daniel ;
Korol, Renee ;
Yu, Eugene ;
Howard, Peter ;
Lochray, Fiona ;
da Costa, Leodante B. ;
Fehlings, Michael G. ;
Sahgal, Arjun .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2012, 84 (03) :E343-E349
[10]  
Fisher CG, 2010, SPINE, V35, pE1221