Helical tomotherapy for spine oligometastases from gastrointestinal malignancies

Abstract

Purpose: This study evaluated the treatment effectiveness and proper radiation dose of helical tomotherapy (HT) in spine oligometastases from gastrointestinal cancers.

Materials and methods: From 2006 to 2010, 20 gastrointestinal cancer patients were treated with HT for spine oligometastases (31 spine lesions). The gross tumor volume (GTV) was the tumor evident from magnetic resonance imaging images fused with simulation computed tomography images. Clinical target volume (CTV) encompassed involved vertebral bodies or dorsal elements. We assumed that the planning target volume was equal to the CTV. We assessed local control rate after HT for 31 spine metastases. Pain response was scored by using a numeric pain intensity scale (NPIS, from 0 to 10).

Results: Spine metastatic lesions were treated with median dose of 40 Gy (range, 24 to 51 Gy) and median 5 Gy per fraction (range, 2.5 to 8 Gy) to GTV with median 8 fractions (range, 3 to 20 fraction). Median biologically equivalent dose (BED, α/β = 10 Gy) was 52 Gy(10) (range, 37.5 to 76.8 Gy(10)) to GTV. Six month local control rate for spine metastasis was 90.3%. Overall infield failure rate was 15% and outfield failure rate was 75%. Most patients showed pain relief after HT (93.8%). Median local recurrence free survival was 3 months. BED over 57 Gy(10) and oligometastases were identified as prognostic factors associated with improved local progression free survival (p = 0.012, p = 0.041).

Conclusion: HT was capable of delivering higher BED to metastatic lesions in close proximity of the spinal cord. Spine metastases from gastrointestinal tumors were sensitive to high dose radiation, and BED (α/β = 10 Gy) higher than 57 Gy(10) could improve local control.

Keywords: Helical tomotherapy; Spine metastasis.

Fig. 1

Local progression free survival.

Fig. 2

Progression free survival according to local control. Three patients in local control (-) group and 17 patients in local control (+) group.

Fig. 3

Local progression free survival rate according to biological effective dose (BED₁₀ 57 Gy₁₀) of the Tomotherapy. Six patients in BED₁₀ > 57 Gy₁₀ group and 14 patients in BED₁₀ ≤ 57 Gy₁₀ group.

Fig. 4

Progression free survival rate according to biological effective dose (BED₁₀ 57 Gy₁₀) of the Tomotherapy. Six patients in BED₁₀ > 57 Gy₁₀ group and 14 patients in BED₁₀ ≤ 57 Gy₁₀ group.

Fig. 5

Illustration of a patient case with hepatocellular carcinoma multiple metastasis in the L1 vertebra body. Positron emission tomography-computed tomography (PET-CT) before Tomotherapy showed hypermetabolic lesion in L1 (A). Prescriptive radiation dose to gross tumor volume (GTV) and clinical target volume (CTV) were 48 Gy and 24 Gy with 8 fractions, respectively (B). On 6 months after Tomotherapy, there was no viable tumor lesion on previous tumor site in PET-CT (C).