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Radiother Oncol. 2019 Sep;138:80-85. doi: 10.1016/j.radonc.2019.06.003. Epub 2019 Jun 25.

Low incidence of late failure and toxicity after spine stereotactic radiosurgery: Secondary analysis of phase I/II trials with long-term follow-up.

Author information

1
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
2
Cancer Specialists of North Florida, Jacksonville, USA.
3
Department of Radiation Oncology, Keck School of Medicine of University of Southern California, USA.
4
Department of Gentourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
5
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, USA.
6
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA.
7
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
8
Department of Radiation Oncology, Mayo Clinic, Rochester, USA.
9
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: ajghia@mdanderson.org.

Abstract

BACKGROUND AND PURPOSE:

To characterize local control and late toxicity in long-term survivors prospectively-treated with spine stereotactic radiosurgery (SSRS).

MATERIALS AND METHODS:

From 2002 to 2011, 228 patients were prospectively-treated on protocol for metastatic disease of 261 vertebral sites. A subset of 52 patients surviving >4 years following treatment were collectively treated for 58 sites (encompassing 69 vertebrae) and underwent secondary analysis. Of all sites, 9% received prior radiation, and 16% encompassed multiple contiguous vertebrae. Radiation prescriptions were most commonly 24 Gy in 1 and 27 Gy in 3 fractions. Outcomes were evaluated via Kaplan-Meier, and associations analyzed via logistic regression.

RESULTS:

Median follow-up was 6.7 years (range: 49-142 months). Five-year local control by site was 91%, with late failures (>2 years) occurring in 3%. Overall and Grade ≥3 late toxicities (>2 years) were observed in 5% and 2% of sites. The last known neurologic event (grade 2 radiculopathy) was noted 2.1 years post-treatment, while the last documented fracture occurred at 4.1 years. No Grade ≥3 events were witnessed after 3.1 years post-SSRS, and no toxicities were noted after 4.1 years through end of follow-up. Re-irradiation, number of segments treated per site (1 vs. 2-3), and fractionation (1 vs. 3-5) were not associated with failure or toxicity.

CONCLUSION:

SSRS maintains excellent disease control and a favorable late toxicity profile even among long-term survivors, with very few failures or toxicities after 2 years in this prospectively-treated population. Overall, these data support the durable control and long-term safety of SSRS with extended follow-up.

KEYWORDS:

Bone; Fractures; Radiosurgery; Spinal cord injuries; Spinal metastases; Survivorship

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