scholarly journals Spine stereotactic radiosurgery for metastatic sarcoma: patterns of failure and radiation treatment volume considerations

2017 ◽  
Vol 27 (3) ◽  
pp. 303-311 ◽  
Author(s):  
Andrew J. Bishop ◽  
Randa Tao ◽  
B. Ashleigh Guadagnolo ◽  
Pamela K. Allen ◽  
Neal C. Rebueno ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Soft Tissues ◽  
Radiation Treatment ◽  
Spinal Metastases ◽  
Local Relapse ◽  
Tumor Control ◽  
High Dose ◽  
Patterns Of Failure ◽  
Local Recurrences ◽  
Treatment Volume

OBJECTIVEGiven the relatively lower radiosensitivity of sarcomas and the locally infiltrative patterns of spread, the authors sought to investigate spine stereotactic radiosurgery (SSRS) outcomes for metastatic sarcomas and to analyze patterns of failure.METHODSThe records of 48 patients with 66 sarcoma spinal metastases consecutively treated with SSRS between 2002 and 2013 were reviewed. The Kaplan-Meier method was used to estimate rates of overall survival (OS) and local control (LC). Local recurrences were categorized as occurring infield (within the 95% isodose line [IDL]), marginally (between the 20% and 95% IDLs), or out of field.RESULTSMedian follow-up time was 19 months (range 1–121 months), and median age was 53 years (range 17–85 years). The most commonly treated histology was leiomyosarcoma (42%). Approximately two-thirds of the patients were treated with definitive SSRS (44 [67%]) versus postoperatively (22 [33%]). The actuarial 1-year OS and LC rates were 67% and 81%, respectively. Eighteen patients had a local relapse, which was more significantly associated with postoperative SSRS (p = 0.04). On multivariate modeling, receipt of postoperative SSRS neared significance for poorer LC (p = 0.06, subhazard ratio [SHR] 2.33), while only 2 covariates emerged as significantly correlated with LC: 1) biological equivalent dose (BED) > 48 Gy (vs BED ≤ 48 Gy, p = 0.006, SHR 0.21) and 2) single vertebral body involvement (vs multiple bodies, p = 0.03, SHR 0.27). Of the 18 local recurrences, 14 (78%) occurred at the margin, and while the majority of these cases relapsed within the epidural space, 4 relapsed within the paraspinal soft tissue. In addition, 1 relapse occurred out of field. Finally, the most common acute toxicity was fatigue (15 cases), with few late toxicities (4 insufficiency fractures, 3 neuropathies).CONCLUSIONSFor metastatic sarcomas, SSRS provides durable tumor control with minimal toxicity. High-dose single-fraction regimens offer optimal LC, and given the infiltrative nature of sarcomas, when paraspinal soft tissues are involved, larger treatment volumes may be warranted.

scholarly journals Stereotactic radiosurgery for treating meningiomas eligible for complete resection

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Maximilian I. Ruge ◽  
Juman Tutunji ◽  
Daniel Rueß ◽  
Eren Celik ◽  
Christian Baues ◽  
...  
Keyword(s):  
Adverse Events ◽  
Stereotactic Radiosurgery ◽  
Medical Condition ◽  
Local Tumor Control ◽  
Complete Resection ◽  
Neurological Deficits ◽  
Tumor Control ◽  
Recurrence Rates ◽  
Treatment Volume

Abstract Background For meningiomas, complete resection is recommended as first-line treatment while stereotactic radiosurgery (SRS) is established for meningiomas of smaller size considered inoperable. If the patient´s medical condition or preference excludes surgery, SRS remains a treatment option. We evaluated the efficacy and safety of SRS in a cohort comprising these cases. Methods In this retrospective single-centre analysis we included patients receiving single fraction SRS either by modified LINAC or robotic guidance by Cyberknife for potentially resectable intracranial meningiomas. Treatment-related adverse events as well as local and regional control rates were determined from follow-up imaging and estimated by the Kaplan–Meier method. Results We analyzed 188 patients with 218 meningiomas. The median radiological, and clinical follow-up periods were 51.4 (6.2–289.6) and 55.8 (6.2–300.9) months. The median tumor volume was 4.2 ml (0.1–22), and the mean marginal radiation dose was 13.0 ± 3.1 Gy, with reference to the 80.0 ± 11.2% isodose level. Local recurrence was observed in one case (0.5%) after 239 months. The estimated 2-, 5-, 10- and 15-year regional recurrence rates were 1.5%, 3.0%, 6.6% and 6.6%, respectively. Early adverse events (≤ 6 months after SRS) occurred in 11.2% (CTCEA grade 1–2) and resolved during follow-up in 7.4% of patients, while late adverse events were documented in 14.4% (grade 1–2; one case grade 3). Adverse effects (early and late) were associated with the presence of symptoms or neurological deficits prior to SRS (p < 0.03) and correlated with the treatment volume (p < 0.02). Conclusion In this analysis SRS appears to be an effective treatment for patients with meningiomas eligible for complete resection and provides reliable long-term local tumor control with low rates of mild morbidity.

scholarly journals Image-guided radiosurgery in the treatment of spinal metastases

2001 ◽  
Vol 11 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Martin J. Murphy ◽  
Steven Chang ◽  
Iris Gibbs ◽  
Quynh-Tu Le ◽  
David Martin ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Therapeutic Option ◽  
Spinal Metastases ◽  
Target Volume ◽  
Outpatient Setting ◽  
Spinal Tumors ◽  
High Dose ◽  
Radiation Beam ◽  
Image Guided ◽  
Frameless Radiosurgery

Object The authors describe a new method for treating metastatic spinal tumors in which noninvasive, image-guided, frameless stereotactic radiosurgery is performed. Stereotactic radiosurgery delivers a high dose of radiation in a single or limited number of fractions to a lesion while maintaining delivery of a low dose to adjacent normal structures. Methods Image-guided radiosurgery was developed by coupling an orthogonal pair of real-time x-ray cameras to a dynamically manipulated robot-mounted linear accelerator that guides the radiation beam to treatment sites associated with radiographic landmarks. This procedure can be conducted in an outpatient setting without the use of frame-based skeletal fixation. The system relies on skeletal landmarks or implanted fiducial markers to locate treatment targets. Four patients with spinal metastases underwent radiosurgery with total prescription doses of 1000 to 1600 cGy in one or two fractions. Alignment of the treatment dose with the target volume was accurate to within 1.5 mm. During the course of each treatment fraction, patient movement was less than 0.5 mm on average. Dosimetry was highly conformal, with a demonstrated ability to deliver 1600 cGy to the perimeter of an irregular target volume while keeping exposure to the cord itself below 800 cGy. Conclusions These experiences indicate that frameless radiosurgery is a viable therapeutic option for metastatic spine disease.

Patterns of failure after single-dose radiosurgery for spinal metastasis

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 402-405 ◽  
Author(s):  
Samuel Ryu ◽  
Jack Rock ◽  
Mark Rosenblum ◽  
Jae Ho Kim
Keyword(s):  
Single Dose ◽  
Pain Control ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Tumor Control ◽  
Effective Treatment Option ◽  
Patterns Of Failure ◽  
Content Type ◽  
Spinal Radiosurgery ◽  
Fine Print

Object. Single-dose radiosurgery for solitary spinal metastases can achieve rapid and durable pain control. This study was conducted to determine the patterns of failure after spinal radiosurgery. Methods. Forty-nine patients with 61 solitary spinal metastases underwent radiosurgery between May 2001 and May 2003. Single-dose radiosurgery (10–16 Gy) was delivered only to the involved spinal segments. The authors undertook a retrospective review of clinical notes, including patient questionnaires and radiological studies (computerized tomography or magnetic resonance imaging), to analyze patterns of failure following radiosurgery with regard to the pain and tumor control. Complete and partial pain relief was achieved in 85% of the lesions treated. Relapse of pain at the treated site was noted in 7%. Radiologically, lesions progressively metastasized to the immediately adjacent spines in 5%. These patients also had progressive primary and/or other systemic metastatic diseases. Conclusions. Spine-related pain control/reduction was excellent. Tumor recurrence at the treated segment and progression to the immediately adjacent region were rare. The results support the use of spinal radiosurgery as an effective treatment option for solitary spinal metastasis.

scholarly journals Local disease control for spinal metastases following “separation surgery” and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients

2013 ◽  
Vol 18 (3) ◽  
pp. 207-214 ◽  
Author(s):  
Ilya Laufer ◽  
J. Bryan Iorgulescu ◽  
Talia Chapman ◽  
Eric Lis ◽  
Weiji Shi ◽  
...  
Keyword(s):  
Low Dose ◽  
Spinal Metastases ◽  
Local Tumor Control ◽  
Surgical Decompression ◽  
Tumor Control ◽  
High Dose ◽  
Local Tumor ◽  
Single Fraction ◽  
Tumor Histology ◽  
Local Progression

Object Decompression surgery followed by adjuvant radiotherapy is an effective therapy for preservation or recovery of neurological function and achieving durable local disease control in patients suffering from metastatic epidural spinal cord compression (ESCC). The authors examine the outcomes of postoperative image-guided intensity-modulated radiation therapy delivered as single-fraction or hypofractionated stereotactic radiosurgery (SRS) for achieving long-term local tumor control. Methods A retrospective chart review identified 186 patients with ESCC from spinal metastases who were treated with surgical decompression, instrumentation, and postoperative radiation delivered as either single-fraction SRS (24 Gy) in 40 patients (21.5%), high-dose hypofractionated SRS (24–30 Gy in 3 fractions) in 37 patients (19.9%), or low-dose hypofractionated SRS (18–36 Gy in 5 or 6 fractions) in 109 patients (58.6%). The relationships between postoperative adjuvant SRS dosing and fractionation, patient characteristics, tumor histology–specific radiosensitivity, grade of ESCC, extent of surgical decompression, response to preoperative radiotherapy, and local tumor control were evaluated by competing risks analysis. Results The total cumulative incidence of local progression was 16.4% 1 year after SRS. Multivariate Gray competing risks analysis revealed a significant improvement in local control with high-dose hypofractionated SRS (4.1% cumulative incidence of local progression at 1 year, HR 0.12, p = 0.04) as compared with low-dose hypofractionated SRS (22.6% local progression at 1 year, HR 1). Although univariate analysis demonstrated a trend toward greater risk of local progression for patients in whom preoperative conventional external beam radiation therapy failed (22.2% local progression at 1 year, HR 1.96, p = 0.07) compared with patients who did not receive any preoperative radiotherapy (11.2% local progression at 1 year, HR 1), this association was not confirmed with multivariate analysis. No other variable significantly correlated with progression-free survival, including radiation sensitivity of tumor histology, grade of ESCC, extent of surgical decompression, or patient sex. Conclusions Postoperative adjuvant SRS following epidural spinal cord decompression and instrumentation is a safe and effective strategy for establishing durable local tumor control regardless of tumor histology–specific radiosensitivity. Patients who received high-dose hypofractionated SRS demonstrated 1-year local progression rates of less than 5% (95% CI 0%–12.2%), which were superior to the results of low-dose hypofractionated SRS. The local progression rate after single-fraction SRS was less than 10% (95% CI 0%–19.0%).

scholarly journals MammoSite brachytherapy: evolution and current status

2006 ◽  
Vol 9 (10) ◽  
pp. 1-4
Author(s):  
R. Rabinovitch ◽  
A. Schwer
Keyword(s):  
Radiation Treatment ◽  
High Dose Rate ◽  
Current Status ◽  
Tumor Control ◽  
High Dose ◽  
Radiation Oncologist ◽  
Breast Conserving Treatment ◽  
Number Of Patients ◽  
Future Direction ◽  
Effects Of Radiation

Brachytherapy treatment consists of the insertion of radioactive sources into tissue to deliver radiotherapy directly to the tumor. Early treatment utilizing this method required intra-operative placement of 15–20 catheters by the radiation oncologist, a highly specialized procedure which limited its widespread use despite encouraging results from the first clinical trial and the benefits to the patient of receiving radiation treatment to only 2 cm of tissue beyond the borders of the lumpectomy cavity and the ability to complete the radiotherapy component of breast conserving treatment in 4–5 days, instead of the usual 4–6 weeks. The MammoSite® Radiation Therapy System allows either a radiation oncologist or a surgeon to implant a much simplified brachytherapy device, thus increasing the number of patients who can receive this treatment. The device, which received FDA approval in May 2002, works by creating a cavity inside the lumpectomy site via a balloon. A high dose-rate brachytherapy source is inserted into this cavity, evenly irradiating the tissue at highest risk of containing residual cancer cells. Data collected since its approval show that MammoSite offers tumor control equal to traditional radiotherapy with fewer side effects of radiation exposure to nearby tissues. However, the invasive nature and high cost of this treatment mean that MammoSite should not be seen as the sole future direction of radiotherapy treatment delivery methods.

scholarly journals Stereotactic radiation treatment for benign meningiomas

2007 ◽  
Vol 23 (4) ◽  
pp. E5 ◽  
Author(s):  
Andrew E. H. Elia ◽  
Helen A. Shih ◽  
Jay S. Loeffler
Keyword(s):  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Radiation Treatment ◽  
Optic Chiasm ◽  
External Beam Radiation ◽  
Tumor Control ◽  
Beam Radiation ◽  
Stereotactic Radiation ◽  
Clinical Scenarios ◽  
Toxicity Equivalent

✓Meningiomas are the second most common primary tumor of the brain. Gross-total resection remains the preferred treatment if achievable with minimal morbidity. For incompletely resected or inoperable benign meningiomas, 3D conformal external-beam radiation therapy can provide durable local tumor control in 90 to 95% of cases. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) are highly conformal techniques, using steep dose gradients and stereotactic patient immobilization. Stereotactic radiosurgery has been used as an alternative or adjuvant therapy to surgery for meningiomas in locations, such as the skull base, where operative manipulation may be particularly difficult. Stereotactic radiotherapy is useful for larger meningiomas (> 3–3.5 cm) and those closely approximating critical structures, such as the optic chiasm and brainstem. Although SRS has longer follow-up than SRT, both techniques have excellent 5-year tumor control rates of greater than 90% for benign meningiomas. Stereotactic radiotherapy has toxicity equivalent to that of radiosurgery, despite its biased use for larger meningiomas with more complicated volumes. Reported rates of imaging-documented regression are higher for radiosurgery, but neurological recovery is relatively good with both techniques. Stereotactic radiosurgery and fractionated SRT are complementary techniques appropriate for different clinical scenarios.

Integrating Evidence-Based Medicine for Treatment of Spinal Metastases Into a Decision Framework: Neurologic, Oncologic, Mechanicals Stability, and Systemic Disease

2017 ◽  
Vol 35 (21) ◽  
pp. 2419-2427 ◽  
Author(s):  
Ori Barzilai ◽  
Ilya Laufer ◽  
Yoshiya Yamada ◽  
Daniel S. Higginson ◽  
Adam M. Schmitt ◽  
...  
Keyword(s):  
Organs At Risk ◽  
Systemic Disease ◽  
Spinal Metastases ◽  
Current Evidence ◽  
Tumor Control ◽  
High Dose ◽  
Mechanical Instability ◽  
Decision Framework ◽  
Clear Trend ◽  
Definitive Therapy

Patients with cancer are frequently affected by spinal metastases. Treatment is palliative, with the principle goals of pain relief, preservation of neurologic function, and improvement in quality of life. In the past decade, we have witnessed a dramatic change in the treatment paradigms due to the development of improved surgical strategies and systemic and radiation therapy. The most important change to these paradigms has been the integration of spinal stereotactic radiosurgery (SSRS), allowing delivery of tumoricidal radiation doses with sparing of nearby organs at risk. High-dose SSRS provides durable tumor control when used either as definitive therapy or as a postoperative adjuvant therapy. Integration of SSRS has fundamentally changed the indications for and type of surgery performed for metastatic spine tumors. Although the role for surgical intervention is well established, a clear trend toward less-aggressive, often minimally invasive techniques has been observed. Targeted therapies are also rapidly changing the way cancer is being treated and have demonstrated improved survival for a number of malignancies. As these treatment decisions become more complex, a multidisciplinary approach including medical oncologists, radiation oncologists, surgeons, interventionalists, and pain specialists is required. In this article, the current evidence affecting the treatment of spinal metastases is integrated into a decision framework that considers four principal assessments of a patient’s spine disease: NOMS (neurologic, oncologic, mechanical instability, and systemic disease).

A common sense approach to radiation treatment planning of temporal lobe GBM

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 2044-2044
Author(s):  
F. Bokstein ◽  
F. Kovner ◽  
Z. Ram ◽  
H. Templehoff ◽  
A. A. Kanner ◽  
...  
Keyword(s):  
Temporal Bone ◽  
Temporal Lobe ◽  
Stable Disease ◽  
Radiation Treatment ◽  
Combined Modality Therapy ◽  
Infratemporal Fossa ◽  
Tumor Control ◽  
High Dose ◽  
Tumor Spread ◽  
Local Progression

2044 Background: Irradiation remains the cornerstone of management for glioblastoma multiforme (GBM). Guidelines adopted by the RTOG and EORTC advocate encompassing the primary tumor (sometimes with edema), and a 2 cm margin in the high dose volume. These recommendations have emerged from imaging studies and post-mortem analyses. A shortcoming of this approach is the exposure of critical structures (e.g. optic apparatus) to doses of radiation that may exceed organ tolerance. We sought to determine whether the temporal bone (rather than the aforementioned 2 cm radius) serves as a barrier to tumor spread when regarded as the anterior margin for temporal lobe lesions. We hypothesized that toxicity could be reduced without compromising tumor control. Methods: During the period 2003–2006, 250 patients with GBM were treated with surgery and primary irradiation at our institution. Chemotherapy (e.g., Stupp regimen) was given to approximately one-third of patients. 31 patients had lesions confined to the temporal lobe. All patients had MRI at baseline and at monthly intervals following a course of 60 Gy delivered by conformal techniques. The Clinical Target Volume included the primary lesion, the edema when present and a 2 cm margin except in the direction of the temporal bone. At follow-up (median = 10 months), patients were judged to have stable disease, local progression (i.e. failure within the temporal lobe), distant progression (i.e., brain failure beyond the temporal lobe) or combinations of the latter 2. Results: 11 patients have remained with stable disease. 17 have failed locally. 3 have manifested distant failure. Of the latter, only one patient failed in the infratemporal fossa. Conclusions: An acceptable level of recurrence (e.g., <5% beyond the temporal bone) is seen when the temporal bone, rather than a 2 cm margin is employed as the anterior border of the CTV. As GBM patients live longer in the era of combined modality therapy, a greater opportunity will exist to express radiation damage. The strategy proposed herein provides tumor control while respecting optic tolerance without resorting to complex, expensive approaches such as IMRT. No significant financial relationships to disclose.

Single-fraction radiosurgery for the treatment of renal tumors in singular renal units.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 368-368
Author(s):  
M. D. Staehler ◽  
P. Nuhn ◽  
A. Karl ◽  
M. Bader ◽  
C. Stief ◽  
...  
Keyword(s):  
Radiation Treatment ◽  
Eastern Cooperative Oncology Group ◽  
Skin Toxicity ◽  
Local Tumor Control ◽  
Renal Tumors ◽  
Tumor Control ◽  
High Dose ◽  
Local Tumor ◽  
Single Fraction ◽  
Oncological Treatment

368 Background: High-dose local radiation treatment (stereotactic radiosurgery [SRS]) was added for selected patients to improve local control and overall survival in metastases. We report on toxicity and local tumor control in patients with renal tumors who were treated with aggressive local irradiation using a single fraction SRS with the Cyberknife in singular renal units to avoid hemodialysis. Methods: n=18 patients with renal tumors and an eastern cooperative oncology group (ECOG) status of 0 or 1 were treated with SRS. Patients with surgically removable renal lesions were not included. Prior to SRS gold markers were planted into the renal parenchyma under ultrasonographic guidance. Results: Nine patients had transitional carcinoma of the renal pelvis, six patients had renal cell carcinoma and three had other tumor entities. No skin toxicity occurred after SRS, and SRS did not induce other side effects. Local tumor control 9 months after SRS was 98% (95% CI: 89-99%). There were no treatment related deaths, and late complications after SRS were not noted so far. Renal function so far remained stable without a change in serum creatinine. Conclusions: SRS for selected patients with renal tumors is safe and effective. Single-fraction delivery as an outpatient procedure allows for convenient integration of SRS into various oncological treatment concepts. Further studies are needed to determine the limits of SRS in this setting. No significant financial relationships to disclose.

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