Abstract
BackgroundDue to recent medical advancements, patients suffering from metastatic spinal disease have a prolonged life expectancy than several decades ago, and some will eventually experience relapses. Data for the retreatment of spinal metastasis recurrences occurring at the very same macroscopic spot as the initially treated lesion are limited. Previous studies mainly included recurrences in the boundary areas as well as other macroscopic parts of the initially affected vertebrae. This study exclusively analyzes the efficacy and safety of spinal reirradiation for recurrences on the same site utilizing single-session robotic radiosurgery.Materials and MethodsPatients between 2005 and 2020 who received radiotherapy for a spinal metastasis suffering from a local recurrence were eligible for analysis. Only patients undergoing a single-session reirradiation were included. All recurrences must have been occurred in the same location as the initial lesion. This was defined as a macroscopic recurrence on computed tomography occurring at the same site as the initial spinal metastasis. All other lesions, including those in the boundary areas or other parts of the initially affected vertebrae, were excluded.ResultsFifty-three patients with fifty-three lesions were retreated for spinal metastases. The median dose and number of fractions for the initial radiotherapy were 36 Gy and 15, respectively. Eleven patients were initially treated with stereotactic body radiotherapy. Retreatment was performed with a median dose of 18 Gy prescribed to a median isodose of 70%. The local control was 77% after a median follow-up of 22.2 months. Patients experiencing a second recurrence received a lower dose (p = 0.04), mostly below 18 Gy, and had a worse coverage (p = 0.01) than those showing local tumor control. 51% of patients experienced an improvement in pain control after treatment delivery. Besides, four vertebral compression fractures (7% of patients) but no other adverse events higher than grade 2 were observed.ConclusionSingle-session robotic radiosurgery appears to be a safe, time-saving, and effective treatment modality for spinal metastasis recurrences occurring in the same initial location if a considerable dose and coverage can be applied. Treatment results are comparable to reirradiated metastases in the boundary areas.
Highlights
Due to recent medical advancements, patients suffering from metastatic disease have a prolonged life expectancy than several decades ago [1]
Fifty-three patients treated for a spinal metastasis recurrence between 2005 and 2020 were included in this retrospective single-center study
Diagnosis of spinal metastasis recurrence was made by an interdisciplinary team consisting of radiation oncologists, neurosurgeons, and neuroradiologists
Summary
Due to recent medical advancements, patients suffering from metastatic disease have a prolonged life expectancy than several decades ago [1]. Single-session and multisession SBRT up to 5 fractions showed 1-year-LC rates around 80% for spinal metastases, even for radioresistant tumor entities [6, 8,9,10,11] Still, this implies that a substantial number of patients will experience the need for a follow-up treatment thanks to current and future improvements in systemic therapies, which increase the overall life expectancy for patients with metastatic disease. Previous reports often included spinal recurrences in the boundary area or previously irradiated field and other parts of the initially affected vertebrae, and not just same site relapses [16, 17] This may potentially compromise patient and data homogeneity, which could limit the overall generalizability of the reported results. This study exclusively analyzes the efficacy and safety of spinal reirradiation for recurrences on the same site utilizing singlesession robotic radiosurgery
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