Safety and efficacy of salvage conventional re-irradiation following stereotactic radiosurgery for spine metastases
- Author:
Marcus A. FLOREZ
1
;
Brian DE
;
Bhavana V. CHAPMAN
;
Anussara PRAYONGRAT
;
Jonathan G. THOMAS
;
Thomas H. BECKHAM
;
Chenyang WANG
;
Debra N. YEBOA
;
Andrew J. BISHOP
;
Tina BRIERE
;
Behrang AMINI
;
Jing LI
;
Claudio E. TATSUI
;
Laurence D. RHINES
;
Amol J. GHIA
Author Information
- Publication Type:Original Article
- From:Radiation Oncology Journal 2023;41(1):12-22
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
