Stereotactic body radiotherapy for metastatic spinal sarcoma: A detailed patterns-of-failure study

Jonathan E. Leeman, Mark Bilsky, Ilya Laufer, Michael R. Folkert, Neil K. Taunk, Joseph R. Osborne, Julio Arevalo-Perez, Joan Zatcky, Kaled M. Alektiar, Yoshiya Yamada, Daniel E. Spratt

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective The aim of this study was to report the first detailed analysis of patterns of failure within the spinal axis of patients treated with stereotactic body radiotherapy (SBRT) for sarcoma spine metastases. Methods Between 2005 and 2012, 88 consecutive patients with metastatic sarcoma were treated with SBRT for 120 spinal lesions. Seventy-one percent of patients were enrolled on prospective institutional protocols. For patients who underwent routine posttreatment total-spine MRI (64 patients, 88 lesions), each site of progression within the entire spinal axis was mapped in relation to the treated lesion. Actuarial rates of local-, adjacent-, and distant-segment failure-free survival (FFS) were calculated using the Kaplan-Meier method. Results The median follow-up for the cohort was 14.4 months, with 81.7% of patients followed up until death. The 12-month actuarial rate of local FFS was 85.9%; however, 83.3% of local failures occurred in conjunction with distantsegment failures. The 12-month actuarial rates of isolated local-, adjacent-, and distant-segment FFS were 98.0%, 97.8%, and 74.7%, respectively. Of patients with any spinal progression (n = 55), only 25.5% (n = 14) had progression at a single vertebral level, with 60.0% (n = 33) having progression at ≥ 3 sites within the spine simultaneously. Linear regression analysis revealed a relationship of decreasing risk of failure with increasing distance from the treated index lesion (R2 = 0.87), and 54.1% of failures occurred ≥ 5 vertebral levels away. Treatment of the index lesion with a lower biological effective dose (OR 3.2, 95% CI 1.1-9.2) and presence of local failure (OR 18.0, 95% CI 2.1-152.9) independently predicted for distant spine failure. Conclus ions Isolated local- and adjacent-segment failures are exceptionally rare for patients with metastatic sarcoma to the spine treated with SBRT, thereby affirming the treatment of the involved level only. The majority of progression within the spinal axis occurs ≥ 5 vertebral levels away. Thus, total-spine imaging is necessary for surveillance posttreatment.

Original languageEnglish (US)
Pages (from-to)52-58
Number of pages7
JournalJournal of Neurosurgery: Spine
Volume25
Issue number1
DOIs
StatePublished - Jul 1 2016

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Radiosurgery
Sarcoma
Spine
Survival
Linear Models
Regression Analysis
Ions
Neoplasm Metastasis
Therapeutics

Keywords

  • Oncology
  • Patterns of failure
  • Sarcoma
  • SBRT
  • Spine metastasis
  • Stereotactic body radiotherapy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

Cite this

Stereotactic body radiotherapy for metastatic spinal sarcoma : A detailed patterns-of-failure study. / Leeman, Jonathan E.; Bilsky, Mark; Laufer, Ilya; Folkert, Michael R.; Taunk, Neil K.; Osborne, Joseph R.; Arevalo-Perez, Julio; Zatcky, Joan; Alektiar, Kaled M.; Yamada, Yoshiya; Spratt, Daniel E.

In: Journal of Neurosurgery: Spine, Vol. 25, No. 1, 01.07.2016, p. 52-58.

Research output: Contribution to journalArticle

Leeman, JE, Bilsky, M, Laufer, I, Folkert, MR, Taunk, NK, Osborne, JR, Arevalo-Perez, J, Zatcky, J, Alektiar, KM, Yamada, Y & Spratt, DE 2016, 'Stereotactic body radiotherapy for metastatic spinal sarcoma: A detailed patterns-of-failure study', Journal of Neurosurgery: Spine, vol. 25, no. 1, pp. 52-58. https://doi.org/10.3171/2015.11.SPINE151059
Leeman, Jonathan E. ; Bilsky, Mark ; Laufer, Ilya ; Folkert, Michael R. ; Taunk, Neil K. ; Osborne, Joseph R. ; Arevalo-Perez, Julio ; Zatcky, Joan ; Alektiar, Kaled M. ; Yamada, Yoshiya ; Spratt, Daniel E. / Stereotactic body radiotherapy for metastatic spinal sarcoma : A detailed patterns-of-failure study. In: Journal of Neurosurgery: Spine. 2016 ; Vol. 25, No. 1. pp. 52-58.
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abstract = "Objective The aim of this study was to report the first detailed analysis of patterns of failure within the spinal axis of patients treated with stereotactic body radiotherapy (SBRT) for sarcoma spine metastases. Methods Between 2005 and 2012, 88 consecutive patients with metastatic sarcoma were treated with SBRT for 120 spinal lesions. Seventy-one percent of patients were enrolled on prospective institutional protocols. For patients who underwent routine posttreatment total-spine MRI (64 patients, 88 lesions), each site of progression within the entire spinal axis was mapped in relation to the treated lesion. Actuarial rates of local-, adjacent-, and distant-segment failure-free survival (FFS) were calculated using the Kaplan-Meier method. Results The median follow-up for the cohort was 14.4 months, with 81.7{\%} of patients followed up until death. The 12-month actuarial rate of local FFS was 85.9{\%}; however, 83.3{\%} of local failures occurred in conjunction with distantsegment failures. The 12-month actuarial rates of isolated local-, adjacent-, and distant-segment FFS were 98.0{\%}, 97.8{\%}, and 74.7{\%}, respectively. Of patients with any spinal progression (n = 55), only 25.5{\%} (n = 14) had progression at a single vertebral level, with 60.0{\%} (n = 33) having progression at ≥ 3 sites within the spine simultaneously. Linear regression analysis revealed a relationship of decreasing risk of failure with increasing distance from the treated index lesion (R2 = 0.87), and 54.1{\%} of failures occurred ≥ 5 vertebral levels away. Treatment of the index lesion with a lower biological effective dose (OR 3.2, 95{\%} CI 1.1-9.2) and presence of local failure (OR 18.0, 95{\%} CI 2.1-152.9) independently predicted for distant spine failure. Conclus ions Isolated local- and adjacent-segment failures are exceptionally rare for patients with metastatic sarcoma to the spine treated with SBRT, thereby affirming the treatment of the involved level only. The majority of progression within the spinal axis occurs ≥ 5 vertebral levels away. Thus, total-spine imaging is necessary for surveillance posttreatment.",
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AU - Taunk, Neil K.

AU - Osborne, Joseph R.

AU - Arevalo-Perez, Julio

AU - Zatcky, Joan

AU - Alektiar, Kaled M.

AU - Yamada, Yoshiya

AU - Spratt, Daniel E.

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N2 - Objective The aim of this study was to report the first detailed analysis of patterns of failure within the spinal axis of patients treated with stereotactic body radiotherapy (SBRT) for sarcoma spine metastases. Methods Between 2005 and 2012, 88 consecutive patients with metastatic sarcoma were treated with SBRT for 120 spinal lesions. Seventy-one percent of patients were enrolled on prospective institutional protocols. For patients who underwent routine posttreatment total-spine MRI (64 patients, 88 lesions), each site of progression within the entire spinal axis was mapped in relation to the treated lesion. Actuarial rates of local-, adjacent-, and distant-segment failure-free survival (FFS) were calculated using the Kaplan-Meier method. Results The median follow-up for the cohort was 14.4 months, with 81.7% of patients followed up until death. The 12-month actuarial rate of local FFS was 85.9%; however, 83.3% of local failures occurred in conjunction with distantsegment failures. The 12-month actuarial rates of isolated local-, adjacent-, and distant-segment FFS were 98.0%, 97.8%, and 74.7%, respectively. Of patients with any spinal progression (n = 55), only 25.5% (n = 14) had progression at a single vertebral level, with 60.0% (n = 33) having progression at ≥ 3 sites within the spine simultaneously. Linear regression analysis revealed a relationship of decreasing risk of failure with increasing distance from the treated index lesion (R2 = 0.87), and 54.1% of failures occurred ≥ 5 vertebral levels away. Treatment of the index lesion with a lower biological effective dose (OR 3.2, 95% CI 1.1-9.2) and presence of local failure (OR 18.0, 95% CI 2.1-152.9) independently predicted for distant spine failure. Conclus ions Isolated local- and adjacent-segment failures are exceptionally rare for patients with metastatic sarcoma to the spine treated with SBRT, thereby affirming the treatment of the involved level only. The majority of progression within the spinal axis occurs ≥ 5 vertebral levels away. Thus, total-spine imaging is necessary for surveillance posttreatment.

AB - Objective The aim of this study was to report the first detailed analysis of patterns of failure within the spinal axis of patients treated with stereotactic body radiotherapy (SBRT) for sarcoma spine metastases. Methods Between 2005 and 2012, 88 consecutive patients with metastatic sarcoma were treated with SBRT for 120 spinal lesions. Seventy-one percent of patients were enrolled on prospective institutional protocols. For patients who underwent routine posttreatment total-spine MRI (64 patients, 88 lesions), each site of progression within the entire spinal axis was mapped in relation to the treated lesion. Actuarial rates of local-, adjacent-, and distant-segment failure-free survival (FFS) were calculated using the Kaplan-Meier method. Results The median follow-up for the cohort was 14.4 months, with 81.7% of patients followed up until death. The 12-month actuarial rate of local FFS was 85.9%; however, 83.3% of local failures occurred in conjunction with distantsegment failures. The 12-month actuarial rates of isolated local-, adjacent-, and distant-segment FFS were 98.0%, 97.8%, and 74.7%, respectively. Of patients with any spinal progression (n = 55), only 25.5% (n = 14) had progression at a single vertebral level, with 60.0% (n = 33) having progression at ≥ 3 sites within the spine simultaneously. Linear regression analysis revealed a relationship of decreasing risk of failure with increasing distance from the treated index lesion (R2 = 0.87), and 54.1% of failures occurred ≥ 5 vertebral levels away. Treatment of the index lesion with a lower biological effective dose (OR 3.2, 95% CI 1.1-9.2) and presence of local failure (OR 18.0, 95% CI 2.1-152.9) independently predicted for distant spine failure. Conclus ions Isolated local- and adjacent-segment failures are exceptionally rare for patients with metastatic sarcoma to the spine treated with SBRT, thereby affirming the treatment of the involved level only. The majority of progression within the spinal axis occurs ≥ 5 vertebral levels away. Thus, total-spine imaging is necessary for surveillance posttreatment.

KW - Oncology

KW - Patterns of failure

KW - Sarcoma

KW - SBRT

KW - Spine metastasis

KW - Stereotactic body radiotherapy

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