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J Neurosurg Spine. 2017 Oct;27(4):428-435. doi: 10.3171/2017.2.SPINE16976. Epub 2017 Jul 14.

Reirradiation spine stereotactic body radiation therapy for spinal metastases: systematic review.

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Department of Radiation Oncology, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Division of Physics, Department of Radiation Oncology, University of California, San Francisco, California.
Department Neurosurgery, Ruber Internacional Hospital, Madrid, Spain.
National Hospital for Neurology & Neurosurgery, University College London, United Kingdom.
Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France.
Department of Radiation Oncology and Neurosurgery, Stony Brook University, Stony Brook, New York.
Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; and.
Department of Neurosurgery, University of California, Los Angeles, California, and HCor Neuroscience, São Paulo, Brazil.


OBJECTIVE Spinal metastases that recur after conventional palliative radiotherapy have historically been difficult to manage due to concerns of spinal cord toxicity in the retreatment setting. Spine stereotactic body radiation therapy (SBRT), also known as stereotactic radiosurgery, is emerging as an effective and safe means of delivering ablative doses to these recurrent tumors. The authors performed a systematic review of the literature to determine the clinical efficacy and safety of spine SBRT specific to previously irradiated spinal metastases. METHODS A systematic literature review was conducted, which was specific to SBRT to the spine, using MEDLINE, Embase, Cochrane Evidence-Based Medicine Database, National Guideline Clearinghouse, and CMA Infobase, with further bibliographic review of appropriate articles. Research questions included: 1) Is retreatment spine SBRT efficacious with respect to local control and symptom control? 2) Is retreatment spine SBRT safe? RESULTS The initial literature search retrieved 2263 articles. Of these articles, 160 were potentially relevant, 105 were selected for in-depth review, and 9 studies met all inclusion criteria for analysis. All studies were single-institution series, including 4 retrospective, 3 retrospective series of prospective databases, 1 prospective, and 1 Phase I/II prospective study (low- or very low-quality data). The results indicated that spine SBRT is effective, with a median 1-year local control rate of 76% (range 66%-90%). Improvement in patients' pain scores post-SBRT ranged from 65% to 81%. Treatment delivery was safe, with crude rates of vertebral body fracture of 12% (range 0%-22%) and radiation-induced myelopathy of 1.2%. CONCLUSIONS This systematic literature review suggests that SBRT to previously irradiated spinal metastases is safe and effective with respect to both local control and pain relief. Although the evidence is limited to low-quality data, SBRT can be a recommended treatment option for reirradiation.


BPI = Brief Pain Inventory; CR = complete response; ISRS = International Stereotactic Radiosurgery Society; SBRT = stereotactic body radiotherapy; VCF = vertebral compression fracture; cEBRT = conventional palliative fractionated external-beam radiotherapy; metastases; oncology; retreatment; spine; stereotactic radiation; vertebral body

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