Abstract
The aim of this study is to evaluate the feasibility, safety, and clinical efficacy of CT-guided 125I seed interstitial brachytherapy in patients with recurrent spinal metastases after external beam radiotherapy (EBRT). Between August 2003 and September 2015, 26 spinal metastatic lesions (24 patients) were reirradiated by this salvage therapy modality. Treatment for all patients was preplanned using a three-dimensional treatment planning system 3–5 days before 125I seed interstitial brachytherapy; dosimetry verification was performed immediately after seed implantation. Median actual D 90 was 99 Gy (range, 90–176), and spinal cord median D max was 39 Gy (range, 6–110). Median local control (LC) was 12 months (95% CI: 7.0–17.0). The 6- and 12-month LC rates were 52% and 40%, respectively. Median overall survival (OS) was 11 months (95% CI: 7.7–14.3); 6-month and 1-, 2-, and 3-year OS rates were 65%, 37%, 14%, and 9%, respectively. Pain-free survival ranged from 2 to 42 months (median, 6; 95% CI: 4.6–7.4). Treatment was well-tolerated, with no radiation-induced vertebral compression fractures or myelopathy reported. Reirradiation with CT-guided 125I seed interstitial brachytherapy appears to be feasible, safe, and effective as pain relief or salvage treatment for patients with recurrent spinal metastases after EBRT.
Highlights
Due to developments in cancer treatments, cancer patients are experiencing an increased life expectancy [1]
When a second course of external beam radiotherapy (EBRT) is given using conventional techniques, one must weigh the clinical benefits against the risks of radiation myelopathy, there remains a relative lack of understanding of reirradiation spinal cord tolerance in the literature [9,10,11,12,13]
Higher, focused doses of radiation may be delivered for retreatment; BioMed Research International controversy concerning optimal doses and fraction numbers, planning constraints for stereotactic body radiotherapy (SBRT) of spinal metastases, and patient selection criteria for the choice of treatment still exists in the literature for SBRT
Summary
Due to developments in cancer treatments, cancer patients are experiencing an increased life expectancy [1]. When a second course of EBRT is given using conventional techniques, one must weigh the clinical benefits against the risks of radiation myelopathy, there remains a relative lack of understanding of reirradiation spinal cord tolerance in the literature [9,10,11,12,13]. The spinal cord’s sensitivity to radiation generally precludes high doses to the spine or reirradiation with conventional EBRT techniques [14, 15]. Spine stereotactic body radiotherapy (SBRT) in the reirradiation setting has been extensively investigated in terms of its feasibility, safety, and efficacy [16,17,18]. Higher, focused doses of radiation may be delivered for retreatment; BioMed Research International controversy concerning optimal doses and fraction numbers, planning constraints for SBRT of spinal metastases, and patient selection criteria for the choice of treatment still exists in the literature for SBRT. The cumulative spinal cord dose limits for its use in this setting are unknown
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