Patterns of Failure After Stereotactic Body Radiotherapy to Sacral Metastases

Abstract

AimsStereotactic body radiotherapy (SBRT) is increasingly used to treat sacral metastases. We analysed our centre's local relapse rates and patterns of failure after sacral SBRT and assessed whether using the consensus contouring recommendation (CCR) may have prevented local relapse. Materials and methodsWe conducted a single-centre retrospective review of patients treated with sacral SBRT between February 2012 and December 2021. The cumulative incidence of local relapse, patterns of failure and overall survival were determined. Two investigators reviewed planning computed tomography scans and imaging at relapse to determine if local relapse was potentially preventable with a larger CCR-derived radiotherapy field. ResultsIn total, 34 patients received sacral SBRT, with doses ranging from 24 to 40 Gy over three to five fractions. The most frequently used schedule was 30 Gy in three fractions. Common primaries treated included prostate (n = 16), breast (n = 6), lung (n = 3) and renal (n = 3) cancers. The median follow-up was 20 months (interquartile range 13–55 months). The cumulative incidence of local relapse (4/34) was 2.9% (95% confidence interval 0.2–13.2), 6.3% (95% confidence interval 1.1–18.5) and 16.8% (95% confidence interval 4.7–35.4) at 6 months, 1 year and 2 years, respectively. The patterns of failure were local-only (1/34), local and distant (3/34) and distant relapse (10/34). The overall survival was 96.7% (95% confidence interval 90.5–100) and 90.6% (95% confidence interval 78.6–100) at 1 and 2 years, respectively. For prostate/breast primaries, the cumulative incidence of local relapse was 4.5% (95% confidence interval 0.3–19.4), 4.5% (95% confidence interval 0.3–19.4) and 12.5% (95% confidence interval 1.7–34.8) at 6 months, 1 and 2 years, respectively. Twenty-nine cases (85.3%) deviated from the CCR. Sacral relapse was potentially preventable if the CCR was used in one patient (2.9% of the whole cohort and 25% of the relapsed cohort). DiscussionWe have shown excellent local control rates with sacral SBRT, which was largely planned with a margin expansion approach.