Safety and efficacy of salvage conventional re-irradiation following stereotactic radiosurgery for spine metastases

• 영문명: Safety and efficacy of salvage conventional re-irradiation following stereotactic radiosurgery for spine metastases
• 발행기관: 대한방사선종양학회
• 저자명: Marcus A. Florez Brian De Bhavana V. Chapman Anussara Prayongrat Jonathan G. Thomas
• 간행물 정보: 『대한방사선종양학회지』제41권 제1호, 12~22쪽, 전체 11쪽
• 주제분류: 의약학 > 종양학
• 파일형태: PDF
• 발행일자: 2023.03.30

영문 초록

Purpose: There has been limited work assessing the use of re-irradiation (re-RT) for local failure following stereotactic spinal radiosurgery (SSRS). We reviewed our institutional experience of conventionally-fractionated external beam radiation (cEBRT) for salvage therapy following SSRS local failure. Materials and Methods: We performed a retrospective review of 54 patients that underwent salvage conventional re-RT at previously SSRS-treated sites. Local control following re-RT was defined as the absence of progression at the treated site as determined by magnetic resonance imaging. Results: Competing risk analysis for local failure was performed using a Fine-Gray model. The median follow-up time was 25 months and median overall survival (OS) was 16 months (95% confidence interval [CI], 10.8–24.9 months) following cEBRT re-RT. Multivariable Cox proportional-hazards analysis revealed Karnofsky performance score prior to re-RT (hazard ratio [HR] = 0.95; 95% CI, 0.93– 0.98; p = 0.003) and time to local failure (HR = 0.97; 95% CI, 0.94–1.00; p = 0.04) were associated with longer OS, while male sex (HR = 3.92; 95% CI, 1.64–9.33; p = 0.002) was associated with shorter OS. Local control at 12 months was 81% (95% CI, 69.3–94.0). Competing risk multivariable regression revealed radioresistant tumors (subhazard ratio [subHR] = 0.36; 95% CI, 0.15–0.90; p = 0.028) and epidural disease (subHR = 0.31; 95% CI, 0.12–0.78; p =0.013) were associated with increased risk of local failure. At 12 months, 91% of patients maintained ambulatory function. Conclusion: Our data suggest that cEBRT following SSRS local failure can be used safely and effectively. Further investigation is needed into optimal patient selection for cEBRT in the retreatment setting.

목차

Introduction

Materials and Methods

Results

Discussion and Conclusion

Statement of Ethics

Conflict of Interest

Funding

Author Contributions

Data Availability Statement

References

키워드

Radiosurgery Re-irradiation Radiotherapy dosage Local neoplasm recurrence Neoplasm metastasis