Long-Term Results of Dose-Intensified Fractionated Stereotactic Body Radiation Therapy (SBRT) for Painful Spinal Metastases

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Long-Term Results of Dose-Intensified Fractionated Stereotactic Body Radiation Therapy (SBRT) for Painful Spinal Metastases

Guckenberger, M; Mantel, F; Sweeney, RA; Hawkins, M; Belderbos, J; Ahmed, M; Andratschke, N; ... Flentje, M; + view all (2021) Long-Term Results of Dose-Intensified Fractionated Stereotactic Body Radiation Therapy (SBRT) for Painful Spinal Metastases. International Journal of Radiation Oncology*Biology*Physics , 110 (2) pp. 348-357. 10.1016/j.ijrobp.2020.12.045. Green open access

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Abstract

Purpose: To report long-term outcome of fractionated stereotactic body radiotherapy (SBRT) for painful spinal metastases. / Material and Methods: This prospective single arm multi-center phase 2 clinical trial enrolled 57 patients with 63 painful, unirradiated spinal metastases between March 2012 and July 2015. Patients were treated 48.5 Gy in 10 SBRT fractions (long life expectancy [Mizumoto score ≤4]) or 35 Gy in 5 SBRT fractions (intermediate life expectancy [Mizumoto score 5-9]). Pain response was defined as pain improvement of minimum 2 points on a visual analogue scale (VAS) and net pain relief was defined as the sum of time with pain response (complete and partial) divided by overall follow-up time. / Results: All 57 patients received treatment per-protocol, 32 and 25 patients were treated with 10- and 5-fraction SBRT, respectively. The median follow-up of living patients was 60 months, range 33-74. Of evaluable patients, 82% had complete or partial pain response (responders) at 3 months follow-up (primary endpoint) and pain response remained stable over 5 years. Net pain relief was 74% (95% CI, 65-80%). One-, 3- and 5-year overall survival rates were 59.6% (95% CI, 47-72%), 33.3% (95% CI, 21-46%) and 21% (95% CI, 10-32%), respectively. Freedom from local spinal-metastasis progression was 82% at the last imaging follow-up. Late Grade 3 toxicity was limited to pain in 2 patients (non-responders). There was no case of myelopathy. SBRT resulted in long-term improvements of all Euro-QoL-5D-5L dimensions except Anxiety/Depression. / Conclusions: Fractionated SBRT achieved durable pain response and improved quality-of-life at minimum late toxicity.

Type:	Article
Title:	Long-Term Results of Dose-Intensified Fractionated Stereotactic Body Radiation Therapy (SBRT) for Painful Spinal Metastases
Location:	United States
Open access status:	An open access version is available from UCL Discovery
DOI:	10.1016/j.ijrobp.2020.12.045
Publisher version:	https://doi.org/10.1016/j.ijrobp.2020.12.045
Language:	English
Additional information:	This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification:	UCL UCL > Provost and Vice Provost Offices > UCL BEAMS UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Med Phys and Biomedical Eng
URI:	https://discovery.ucl.ac.uk/id/eprint/10119418