PMID- 26025777
OWN - NLM
STAT- MEDLINE
DCOM- 20151005
LR  - 20220311
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 92
IP  - 5
DP  - 2015 Aug 1
TI  - Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of 
      Predictors of Local Recurrence.
PG  - 1016-1026
LID - S0360-3016(15)00370-3 [pii]
LID - 10.1016/j.ijrobp.2015.03.037 [doi]
AB  - PURPOSE: To investigate local control, survival outcomes, and predictors of local 
      relapse for patients treated with spine stereotactic body radiation therapy. 
      METHODS AND MATERIALS: We reviewed the records of 332 spinal metastases 
      consecutively treated with stereotactic body radiation therapy between 2002 and 
      2012. The median follow-up for all living patients was 33 months (range, 
      0-111 months). Endpoints were overall survival and local control (LC); 
      recurrences were classified as either in-field or marginal. RESULTS: The 1-year 
      actuarial LC and overall survival rates were 88% and 64%, respectively. Patients 
      with local relapses had poorer dosimetric coverage of the gross tumor volume 
      (GTV) compared with patients without recurrence (minimum dose [Dmin] biologically 
      equivalent dose [BED] 23.9 vs 35.1 Gy, P<.001; D98 BED 41.8 vs 48.1 Gy, P=.001; 
      D95 BED 47.2 vs 50.5 Gy, P=.004). Furthermore, patients with marginal recurrences 
      had poorer prescription coverage of the GTV (86% vs 93%, P=.01) compared with 
      those with in-field recurrences, potentially because of more upfront spinal canal 
      disease (78% vs 24%, P=.001). Using a Cox regression univariate analysis, 
      patients with a GTV BED Dmin >/=33.4 Gy (median dose) (equivalent to 14 Gy in 1 
      fraction) had a significantly higher 1-year LC rate (94% vs 80%, P=.001) compared 
      with patients with a lower GTV BED Dmin; this factor was the only significant 
      variable on multivariate Cox analysis associated with LC (P=.001, hazard ratio 
      0.29, 95% confidence interval 0.14-0.60) and also was the only variable 
      significant in a separate competing risk multivariate model (P=.001, hazard ratio 
      0.30, 95% confidence interval 0.15-0.62). CONCLUSIONS: Stereotactic body 
      radiation therapy offers durable control for spinal metastases, but there is a 
      subset of patients that recur locally. Patients with local relapse had 
      significantly poorer tumor coverage, which was likely attributable to treatment 
      planning directives that prioritized the spinal cord constraints over tumor 
      coverage. When possible, we recommend maintaining a GTV Dmin above 14 Gy in 1 
      fraction and 21 Gy in 3 fractions.
CI  - Copyright (c) 2015 Elsevier Inc. All rights reserved.
FAU - Bishop, Andrew J
AU  - Bishop AJ
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer 
      Center, Houston, Texas.
FAU - Tao, Randa
AU  - Tao R
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer 
      Center, Houston, Texas.
FAU - Rebueno, Neal C
AU  - Rebueno NC
AD  - Department of Radiation Dosimetry, The University of Texas MD Anderson Cancer 
      Center, Houston, Texas.
FAU - Christensen, Eva N
AU  - Christensen EN
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer 
      Center, Houston, Texas.
FAU - Allen, Pamela K
AU  - Allen PK
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer 
      Center, Houston, Texas.
FAU - Wang, Xin A
AU  - Wang XA
AD  - Department of Radiation Physics, The University of Texas MD Anderson Cancer 
      Center, Houston, Texas.
FAU - Amini, Behrang
AU  - Amini B
AD  - Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer 
      Center, Houston, Texas.
FAU - Tannir, Nizar M
AU  - Tannir NM
AD  - Department of Genitourinary Medical Oncology, The University of Texas MD Anderson 
      Cancer Center, Houston, Texas.
FAU - Tatsui, Claudio E
AU  - Tatsui CE
AD  - Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 
      Houston, Texas.
FAU - Rhines, Laurence D
AU  - Rhines LD
AD  - Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 
      Houston, Texas.
FAU - Li, Jing
AU  - Li J
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer 
      Center, Houston, Texas.
FAU - Chang, Eric L
AU  - Chang EL
AD  - Department of Radiation Oncology, USC Norris Cancer Hospital, Keck School of 
      Medicine of USC, Los Angeles, California.
FAU - Brown, Paul D
AU  - Brown PD
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer 
      Center, Houston, Texas.
FAU - Ghia, Amol J
AU  - Ghia AJ
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer 
      Center, Houston, Texas. Electronic address: ajghia@mdanderson.org.
LA  - eng
GR  - CA016672/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20150404
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Analysis of Variance
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Recurrence, Local/mortality/*surgery
MH  - Radiosurgery/*methods
MH  - Radiotherapy Dosage
MH  - Spinal Neoplasms/mortality/*secondary/*surgery
MH  - Survival Rate
MH  - Treatment Failure
MH  - Young Adult
EDAT- 2015/05/31 06:00
MHDA- 2015/10/06 06:00
CRDT- 2015/05/31 06:00
PHST- 2014/11/25 00:00 [received]
PHST- 2015/03/16 00:00 [revised]
PHST- 2015/03/30 00:00 [accepted]
PHST- 2015/05/31 06:00 [entrez]
PHST- 2015/05/31 06:00 [pubmed]
PHST- 2015/10/06 06:00 [medline]
AID - S0360-3016(15)00370-3 [pii]
AID - 10.1016/j.ijrobp.2015.03.037 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2015 Aug 1;92(5):1016-1026. doi: 
      10.1016/j.ijrobp.2015.03.037. Epub 2015 Apr 4.