Local Control and Toxicity of Multilevel Spine Stereotactic Body Radiotherapy.

Abstract:

BACKGROUND:Spine stereotactic body radiotherapy (sSBRT) is commonly limited to 1 or 2 vertebral levels given a paucity of efficacy and toxicity data when more than 2 levels are treated. OBJECTIVE:To prove our hypothesis that multilevel sSBRT could provide similar rates of local control (LC) (primary endpoint) and toxicity as single-level treatment using the same clinical target, planning target, and planning organ-at-risk volumes. METHODS:We analyzed consecutive cases of sSBRT treated from 2013 to 2017. Time-to-event outcomes for single-level and multilevel cases were compared using mixed effect Cox models and differences in toxicity rates were evaluated using linear mixed effect models. All models incorporate a patient-level random intercept to account for any within-patient correlation across cases. RESULTS:There were 101 single-level and 84 multilevel sSBRT cases (2-7 continuous vertebral levels). One-year LC was 95% vs 85%, respectively. After adjusting for baseline covariates, dose delivered, and accounting for within-patient correlation, there was no significant difference in time to local failure (hazard ratio, HR 1.79 [0.59-5.4]; P = .30). Pain improved in 83.5% of the 139 initially symptomatic tumors. There were no significant differences in grade 2+ acute or late toxicities between single-level and multilevel sSBRT. CONCLUSION:With rigorous patient immobilization, quality assurance, and image guidance, multilevel sSBRT provides high rates of LC, similar to single-level treatment, without need for larger planning volume margins. Efforts to improve prognostication and case selection for multilevel sSBRT are warranted to ensure that the benefits of improved LC over palliative radiation are justified.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Beeler WH,Speth KA,Broderick MT,Jairath NK,Ballouz D,Gharzai LA,Jackson WC,Kim MM,Owen D,Szerlip NJ,Paradis KC,Spratt DE

doi

10.1093/neuros/nyz348

subject

Has Abstract

pub_date

2020-02-01 00:00:00

pages

E164-E172

issue

2

eissn

0148-396X

issn

1524-4040

pii

5572343

journal_volume

86

pub_type

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