PMID- 38311030 OWN - NLM STAT- MEDLINE DCOM- 20240318 LR - 20240318 IS - 1879-0887 (Electronic) IS - 0167-8140 (Linking) VI - 193 DP - 2024 Apr TI - Definitive single fraction spine stereotactic radiosurgery for metastatic sarcoma: Simultaneous integrated boost is associated with high tumor control and low vertebral fracture risk. PG - 110119 LID - S0167-8140(24)00040-9 [pii] LID - 10.1016/j.radonc.2024.110119 [doi] AB - INTRODUCTION: Sarcoma spinal metastases (SSM) are particularly difficult to manage given their poor response rates to chemotherapy and inherent radioresistance. We evaluated outcomes in a cohort of patients with SSM uniformly treated using single-fraction simultaneous-integrated-boost (SIB) spine stereotactic radiosurgery (SSRS). MATERIALS AND METHODS: A retrospective review was conducted at a single tertiary institution treated with SSRS for SSM between April 2007-April 2023. 16-24 Gy was delivered to the GTV and 16 Gy uniformly to the CTV. Kaplan-Meier analysis was conducted to assess time to progression of disease (PD) with proportionate hazards modelling used to determine hazard ratios (HR) and respective 95 % confidence intervals (CI). RESULTS: 70 patients with 100 lesions underwent SSRS for SSM. Median follow-up was 19.3 months (IQR 7.7-27.8). Median age was 55 years (IQR42-63). Median GTV and CTVs were 14.5 cm(3) (IQR 5-32) and 52.7 cm(3) (IQR 29.5-87.5) respectively. Median GTV prescription dose and biologically equivalent dose (BED) [alpha/beta = 10] was 24 Gy and 81.6 Gy respectively. 85 lesions received 24 Gy to the GTV. 27 % of patients had Bilsky 1b or greater disease. 16 of 100 lesions recurred representing a crude local failure rate of 16 % with a median time to failure of 10.4 months (IQR 5.7-18) in cases which failed locally. 1-year actuarial local control (LC) was 89 %. Median overall survival (OS) was 15.3 months (IQR 7.7-25) from SSRS. Every 1 Gy increase in GTV absolute minimum dose (DMin) across the range (5.8-25 Gy) was associated with a reduced risk of local failure (HR = 0.871 [95 % CI 0.782-0.97], p = 0.009). 9 % of patients developed vertebral compression fractures at a median of 13 months post SSRS (IQR 7-25). CONCLUSION: This study represents one of the most homogenously treated and the largest cohorts of patients with SSM treated with single-fraction SSRS. Despite inherent radioresistance, SSRS confers durable and high rates of local control in SSM without unexpected long-term toxicity rates. CI - Copyright (c) 2024 Elsevier B.V. All rights reserved. FAU - Shanker, Mihir D AU - Shanker MD AD - The University of Texas MD Anderson Cancer Centre, United States; The University of Queensland, Brisbane, Australia. Electronic address: m.shanker@uq.edu.au. FAU - Cavazos, Adriana P AU - Cavazos AP AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - Li, Jing AU - Li J AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - Beckham, Thomas H AU - Beckham TH AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - Yeboa, Debra N AU - Yeboa DN AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - Wang, Chenyang AU - Wang C AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - McAleer, Mary Frances AU - McAleer MF AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - Briere, Tina Marie AU - Briere TM AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - Amini, Behrang AU - Amini B AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - Tatsui, Claudio E AU - Tatsui CE AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - North, Robert Y AU - North RY AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - Alvarez-Breckenridge, Christopher A AU - Alvarez-Breckenridge CA AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - Cezayirli, Phillip Cem AU - Cezayirli PC AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - Rhines, Laurence D AU - Rhines LD AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - Ghia, Amol J AU - Ghia AJ AD - The University of Texas MD Anderson Cancer Centre, United States. FAU - Bishop, Andrew J AU - Bishop AJ AD - The University of Texas MD Anderson Cancer Centre, United States. LA - eng PT - Journal Article DEP - 20240203 PL - Ireland TA - Radiother Oncol JT - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology JID - 8407192 SB - IM MH - Humans MH - Middle Aged MH - *Radiosurgery/adverse effects MH - *Spinal Fractures/etiology MH - *Fractures, Compression/etiology MH - *Spinal Neoplasms/radiotherapy/secondary MH - Neoplasm Recurrence, Local/surgery MH - *Sarcoma/radiotherapy/surgery MH - Retrospective Studies MH - *Neoplasms, Second Primary/etiology COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2024/02/05 00:42 MHDA- 2024/03/18 06:42 CRDT- 2024/02/04 19:28 PHST- 2023/09/01 00:00 [received] PHST- 2024/01/25 00:00 [revised] PHST- 2024/01/29 00:00 [accepted] PHST- 2024/03/18 06:42 [medline] PHST- 2024/02/05 00:42 [pubmed] PHST- 2024/02/04 19:28 [entrez] AID - S0167-8140(24)00040-9 [pii] AID - 10.1016/j.radonc.2024.110119 [doi] PST - ppublish SO - Radiother Oncol. 2024 Apr;193:110119. doi: 10.1016/j.radonc.2024.110119. Epub 2024 Feb 3.