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

Matthew S. Ning, Brian J. Deegan, Jennifer C. Ho, Bhavana V. Chapman, Andrew J. Bishop, Pamela K. Allen, Nizar M. Tannir, Behrang Amini, Tina M. Briere, Xin A. Wang, Claudio E. Tatsui, Laurence D. Rhines, Paul Brown, Jing Li, Amol J. Ghia

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)80-85
Number of pages6
JournalRadiotherapy and Oncology
Volume138
DOIs
StatePublished - Sep 2019

Keywords

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

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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