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. 2024 Aug 1;95(2):380-391.
doi: 10.1227/neu.0000000000002889. Epub 2024 Mar 8.

40 Gray in 5 Fractions for Salvage Reirradiation of Spine Lesions Previously Treated With Stereotactic Body Radiotherapy

Assaf Moore  1   2   3 , Zhigang Zhang  4 , Teng Fei  4 , Lei Zhang  5 , Laura Accomando  5 , Adam M Schmitt  1 , Daniel S Higginson  1 , Boris A Mueller  1 , Melissa Zinovoy  1 , Daphna Y Gelblum  1 , Divya Yerramilli  1 , Amy J Xu  1 , Victoria S Brennan  1 , David M Guttmann  1 , Craig E Grossman  1 , Laura L Dover  1 , Narek Shaverdian  1 , Luke R G Pike  1 , John J Cuaron  1 , Alexandra Dreyfuss  1 , Eric Lis  6 , Ori Barzilai  7 , Mark H Bilsky  7 , Yoshiya Yamada  1
Affiliations

40 Gray in 5 Fractions for Salvage Reirradiation of Spine Lesions Previously Treated With Stereotactic Body Radiotherapy

Assaf Moore et al. Neurosurgery. .

Abstract

Background and purpose: A retrospective single-center analysis of the safety and efficacy of reirradiation to 40 Gy in 5 fractions (reSBRT) in patients previously treated with stereotactic body radiotherapy to the spine was performed.

Methods: We identified 102 consecutive patients treated with reSBRT for 105 lesions between 3/2013 and 8/2021. Sixty-three patients (61.8%) were treated to the same vertebral level, and 39 (38.2%) to overlapping immediately adjacent levels. Local control was defined as the absence of progression within the treated target volume. The probability of local progression was estimated using a cumulative incidence curve. Death without local progression was considered a competing risk.

Results: Most patients had extensive metastatic disease (54.9%) and were treated to the thoracic spine (53.8%). The most common regimen in the first course of stereotactic body radiotherapy was 27 Gy in 3 fractions, and the median time to reSBRT was 16.4 months. At the time of simulation, 44% of lesions had advanced epidural disease. Accordingly, 80% had myelogram simulations. Both the vertebral body and posterior elements were treated in 86% of lesions. At a median follow-up time of 13.2 months, local failure occurred in 10 lesions (9.5%). The 6- and 12-month cumulative incidences of local failure were 4.8% and 6%, respectively. Seven patients developed radiation-related neuropathy, and 1 patient developed myelopathy. The vertebral compression fracture rate was 16.7%.

Conclusion: In patients with extensive disease involvement, reSBRT of spine metastases with 40 Gy in 5 fractions seems to be safe and effective. Prospective trials are needed to determine the optimal dose and fractionation in this clinical scenario.

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References

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