TY - JOUR
T1 - Reirradiation spine stereotactic body radiation therapy for spinal metastases
T2 - Systematic review: International Stereotactic Radiosurgery Society practice guidelines
AU - Myrehaug, Sten
AU - Sahgal, Arjun
AU - Hayashi, Motohiro
AU - Levivier, Marc
AU - Ma, Lijun
AU - Martinez, Roberto
AU - Paddick, Ian
AU - Régis, Jean
AU - Ryu, Samuel
AU - Slotman, Ben
AU - De Salles, Antonio
PY - 2017/10/1
Y1 - 2017/10/1
N2 - OBJECTIVE Spinal metastases that recur after conventional palliative radiotherapy have historically been diffcult to manage due to concerns of spinal cord toxicity in the retreatment setting. Spine stereotactic body radiation therapy (SBRT), also known as stereotactic radiosurgery, is emerging as an effective and safe means of delivering ablative doses to these recurrent tumors. The authors performed a systematic review of the literature to determine the clinical effcacy and safety of spine SBRT specifc to previously irradiated spinal metastases. METHODS A systematic literature review was conducted, which was specifc to SBRT to the spine, using MEDLINE, Embase, Cochrane Evidence-Based Medicine Database, National Guideline Clearinghouse, and CMA Infobase, with further bibliographic review of appropriate articles. Research questions included: 1) Is retreatment spine SBRT effcacious with respect to local control and symptom control? 2) Is retreatment spine SBRT safe? RESULTS The initial literature search retrieved 2263 articles. Of these articles, 160 were potentially relevant, 105 were selected for in-depth review, and 9 studies met all inclusion criteria for analysis. All studies were single-institution series, including 4 retrospective, 3 retrospective series of prospective databases, 1 prospective, and 1 Phase I/II prospective study (low-or very low-quality data). The results indicated that spine SBRT is effective, with a median 1-year local control rate of 76% (range 66%-90%). Improvement in patients' pain scores post-SBRT ranged from 65% to 81%. Treatment delivery was safe, with crude rates of vertebral body fracture of 12% (range 0%-22%) and radiation-induced myelopathy of 1.2%. CONCLUSIONS This systematic literature review suggests that SBRT to previously irradiated spinal metastases is safe and effective with respect to both local control and pain relief. Although the evidence is limited to low-quality data, SBRT can be a recommended treatment option for reirradiation.
AB - OBJECTIVE Spinal metastases that recur after conventional palliative radiotherapy have historically been diffcult to manage due to concerns of spinal cord toxicity in the retreatment setting. Spine stereotactic body radiation therapy (SBRT), also known as stereotactic radiosurgery, is emerging as an effective and safe means of delivering ablative doses to these recurrent tumors. The authors performed a systematic review of the literature to determine the clinical effcacy and safety of spine SBRT specifc to previously irradiated spinal metastases. METHODS A systematic literature review was conducted, which was specifc to SBRT to the spine, using MEDLINE, Embase, Cochrane Evidence-Based Medicine Database, National Guideline Clearinghouse, and CMA Infobase, with further bibliographic review of appropriate articles. Research questions included: 1) Is retreatment spine SBRT effcacious with respect to local control and symptom control? 2) Is retreatment spine SBRT safe? RESULTS The initial literature search retrieved 2263 articles. Of these articles, 160 were potentially relevant, 105 were selected for in-depth review, and 9 studies met all inclusion criteria for analysis. All studies were single-institution series, including 4 retrospective, 3 retrospective series of prospective databases, 1 prospective, and 1 Phase I/II prospective study (low-or very low-quality data). The results indicated that spine SBRT is effective, with a median 1-year local control rate of 76% (range 66%-90%). Improvement in patients' pain scores post-SBRT ranged from 65% to 81%. Treatment delivery was safe, with crude rates of vertebral body fracture of 12% (range 0%-22%) and radiation-induced myelopathy of 1.2%. CONCLUSIONS This systematic literature review suggests that SBRT to previously irradiated spinal metastases is safe and effective with respect to both local control and pain relief. Although the evidence is limited to low-quality data, SBRT can be a recommended treatment option for reirradiation.
KW - Metastases
KW - Oncology
KW - Retreatment
KW - Spine
KW - Stereotactic radiation
KW - Vertebral body
UR - http://www.scopus.com/inward/record.url?scp=85030697876&partnerID=8YFLogxK
U2 - 10.3171/2017.2.SPINE16976
DO - 10.3171/2017.2.SPINE16976
M3 - Review article
C2 - 28708043
AN - SCOPUS:85030697876
VL - 27
SP - 428
EP - 435
JO - Journal of Neurosurgery. Spine
JF - Journal of Neurosurgery. Spine
SN - 1547-5654
IS - 4
ER -