학술논문
Single and Multifraction Spine Stereotactic Body Radiation Therapy and the Risk of Radiation Induced Myelopathy.
Document Type
Academic Journal
Author
Lucido JJ; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.; Mullikin TC; Department of Radiation Oncology, Duke University, Durham, North Carolina.; Abraha F; Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota.; Harmsen WS; Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota.; Vaishnav BD; Weisger Cancer Institute, Novant Health Presbyterian Hospital, Charlotte, North Carolina.; Brinkmann DH; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.; Kowalchuk RO; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.; Marion JT; Department of Radiology, Mayo Clinic, Rochester, Minnesota.; Johnson-Tesch BA; Department of Radiology, Mayo Clinic, Rochester, Minnesota.; El Sherif O; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.; Brown PD; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.; Rose PS; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.; Owen D; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.; Morris JM; Department of Radiology, Mayo Clinic, Rochester, Minnesota.; Waddle MR; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.; Siontis BL; Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota.; Stish BJ; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.; Pafundi DH; Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.; Laack NN; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.; Olivier KR; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.; Park SS; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.; Merrell KW; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Source
Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101677247 Publication Model: eCollection Cited Medium: Print ISSN: 2452-1094 (Print) Linking ISSN: 24521094 NLM ISO Abbreviation: Adv Radiat Oncol Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2452-1094
Abstract
Purpose: This study reports on the risk of radiation-induced myelitis (RM) of the spinal cord from a large single-institutional experience with 1 to 5 fraction stereotactic body radiation therapy (SBRT) to the spine.
Methods and Materials: A retrospective review of patients who received spine SBRT to a radiation naïve level at or above the conus medullaris between 2007 and 2019 was performed. Local failure determination was based on SPIne response assessment in Neuro-Oncology criteria. RM was defined as neurologic symptoms consistent with the segment of cord irradiated in the absence of neoplastic disease recurrence and graded by Common Toxicity Criteria for Adverse Events, version 4.0. Rates of adverse events were estimated and dose-volume statistics from delivered treatment plans were extracted for the planning target volumes and spinal cord.
Results: A total of 353 lesions in 277 patients were identified that met the specified criteria, for which 270, 70, and 13 lesions received 1-, 3-, and 5-fraction treatments, respectively, with a median follow-up of 46 months (95% confidence interval [CI], 41-52 months) for all surviving patients. The median overall survival was 33.0 months (95% CI, 29-43). The median D0.03cc to the spinal cord was 11.7 Gy (interquartile range [IQR], 10.5-12.4), 16.7 Gy (IQR, 12.8-20.6), and 26.0 Gy (IQR, 24.1-28.1), for 1-, 3-, 5-fractions. Using an a/b = 2Gy for the spinal cord, the median single-fraction equivalent-dose (SFED2 ) was 11.7 Gy (IQR, 10.2-12.5 Gy) and the normalized biological equivalent dose (nBED 2/2 ) was 19.9 Gy (IQR, 15.4-22.8 Gy). One patient experienced grade 2 RM after a single-fraction treatment. The cumulative probability of RM was 0.3% (95% CI, 0%-2%).
Conclusions: Spine SBRT is safe while limiting the spinal cord (as defined on treatment planning magnetic resonance imaging or computed tomography myelogram) D0.03cc to less than 14 Gy, 21.9 Gy, and 30 Gy, for 1, 3, and 5-fractions, consistent with standard guidelines.
(© 2022 The Authors.)
Methods and Materials: A retrospective review of patients who received spine SBRT to a radiation naïve level at or above the conus medullaris between 2007 and 2019 was performed. Local failure determination was based on SPIne response assessment in Neuro-Oncology criteria. RM was defined as neurologic symptoms consistent with the segment of cord irradiated in the absence of neoplastic disease recurrence and graded by Common Toxicity Criteria for Adverse Events, version 4.0. Rates of adverse events were estimated and dose-volume statistics from delivered treatment plans were extracted for the planning target volumes and spinal cord.
Results: A total of 353 lesions in 277 patients were identified that met the specified criteria, for which 270, 70, and 13 lesions received 1-, 3-, and 5-fraction treatments, respectively, with a median follow-up of 46 months (95% confidence interval [CI], 41-52 months) for all surviving patients. The median overall survival was 33.0 months (95% CI, 29-43). The median D0.03cc to the spinal cord was 11.7 Gy (interquartile range [IQR], 10.5-12.4), 16.7 Gy (IQR, 12.8-20.6), and 26.0 Gy (IQR, 24.1-28.1), for 1-, 3-, 5-fractions. Using an a/b = 2Gy for the spinal cord, the median single-fraction equivalent-dose (SFED
Conclusions: Spine SBRT is safe while limiting the spinal cord (as defined on treatment planning magnetic resonance imaging or computed tomography myelogram) D0.03cc to less than 14 Gy, 21.9 Gy, and 30 Gy, for 1, 3, and 5-fractions, consistent with standard guidelines.
(© 2022 The Authors.)