Author(s): Folkert MR, Bilsky MH, Tom AK, Oh JH, Alektiar KM,
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Abstract PURPOSE: Conventional radiation treatment (20-40 Gy in 5-20 fractions, 2-5 Gy per fraction) for sarcoma metastatic to the spine provides subtherapeutic doses, resulting in poor durable local control (LC) (50\%-77\% at 1 year). Hypofractionated (HF) and/or single-fraction (SF) image-guided stereotactic radiosurgery (IG-SRS) may provide a more effective means of managing these lesions. METHODS AND MATERIALS: Patients with pathologically proven high-grade sarcoma metastatic to the spine treated with HF and SF IG-SRS were included. LC and overall survival (OS) were analyzed by the use of Kaplan-Meier statistics. Univariate and multivariate analyses were performed by the use of Cox regression with competing-risks analysis; all confidence intervals are 95\%. Toxicities were assessed according to Common Terminology Criteria for Adverse Events, version 4.0. RESULTS: From May 2005 to November 11, 2012, 88 patients with 120 discrete metastases received HF (3-6 fractions; median dose, 28.5 Gy; n=52, 43.3\%) or SF IG-SRS (median dose, 24 Gy; n=68, 56.7\%). The median follow-up time was 12.3 months. At 12 months, LC was 87.9\% (confidence interval [CI], 81.3\%-94.5\%), OS was 60.6\% (CI, 49.6\%-71.6\%), and median survival was 16.9 months. SF IG-SRS demonstrated superior LC to HF IG-SRS (12-month LC of 90.8\% [CI, 83\%-98.6\%] vs 84.1\% [CI, 72.9\%-95.3\%] P=.007) and retained significance on multivariate analysis (P=.030, hazard ratio 0.345; CI, 0.132-0.901]. Treatment was well tolerated, with 1\% acute grade 3 toxicity, 4.5\% chronic grade 3 toxicity, and no grade >3 toxicities. CONCLUSIONS: In the largest series of metastatic sarcoma to the spine to date, IG-SRS provides excellent LC in the setting of an aggressive disease with low radiation sensitivity and poor prognosis. Single-fraction IG-SRS is associated with the highest rates of LC with minimal toxicity. Copyright © 2014. Published by Elsevier Inc.
This article was published in Int J Radiat Oncol Biol Phys
and referenced in Journal of Palliative Care & Medicine