Aims: Radiotherapy has a known role in the treatment of symptomatic spinal bone metastases, but there is a relative paucity of data for ablative treatments. The aim of our study is to evaluate the efficacy and toxicity of stereotactic body radiotherapy (SBRT) in treating spinal oligometastases. Methods: A series of spinal oligometastatic patients was treated between 2018 and 2023. The clinical target volume was defined according to Cox contouring guidelines. When feasible, a simultaneous integrated boost (SIB) was administered to the site of the macroscopic disease. The primary end-point was local progression-free survival (LPFS). Secondary objectives were toxicity, distant progression-free survival (DPFS), and overall survival (OS). The following covariates were evaluated: SIB, biologically effective dose, histology, number of total metastases (including both spinal and extra-spinal), and concurrent systemic therapy. Results: One hundred and fifty-two spinal oligometastases in 120 patients were treated. Median follow-up was 22 months (range 6–72, with an interquartile range (IQR) of 21 months). Median dose was 24 Gy (range 21–30) delivered in 3 (3–5) fractions. The most common fractionation was 24 Gy in 3 fractions (49 metastases, 32.2%) SIB was administered in 33 metastases (21.7%). One-, and 2-year LPFS rates were 92.1% and 90%, respectively. Moreover, SIB resulted in a significantly improved 2-year LPFS (P = 0.037). Fourteen (9.2%) metastases locally relapsed. One- and 2-years OS were 94.8% and 90%, respectively. One- and 2-years DPFS were 47.8% and 30.8%, respectively, with a median DPFS of 11 months. Oligometastatic prostate cancer patients showed better polymetastases-free survival (PMFS) (P = 0.03) and DPFS (P = 0.008) than other histologies. Conclusions: Spinal SBRT is effective in treating spinal oligometastases. Dose boost could be safely administered to significantly improve LPFS. Prostate cancer patients showed better outcomes.
Stereotactic Body Radiotherapy for Spinal Oligometastases With or Without Simultaneous Integrated Boost: Results From a Monocentric Retrospective Analysis
Pastorello, E;Rigo, M;Alongi, F
2025-01-01
Abstract
Aims: Radiotherapy has a known role in the treatment of symptomatic spinal bone metastases, but there is a relative paucity of data for ablative treatments. The aim of our study is to evaluate the efficacy and toxicity of stereotactic body radiotherapy (SBRT) in treating spinal oligometastases. Methods: A series of spinal oligometastatic patients was treated between 2018 and 2023. The clinical target volume was defined according to Cox contouring guidelines. When feasible, a simultaneous integrated boost (SIB) was administered to the site of the macroscopic disease. The primary end-point was local progression-free survival (LPFS). Secondary objectives were toxicity, distant progression-free survival (DPFS), and overall survival (OS). The following covariates were evaluated: SIB, biologically effective dose, histology, number of total metastases (including both spinal and extra-spinal), and concurrent systemic therapy. Results: One hundred and fifty-two spinal oligometastases in 120 patients were treated. Median follow-up was 22 months (range 6–72, with an interquartile range (IQR) of 21 months). Median dose was 24 Gy (range 21–30) delivered in 3 (3–5) fractions. The most common fractionation was 24 Gy in 3 fractions (49 metastases, 32.2%) SIB was administered in 33 metastases (21.7%). One-, and 2-year LPFS rates were 92.1% and 90%, respectively. Moreover, SIB resulted in a significantly improved 2-year LPFS (P = 0.037). Fourteen (9.2%) metastases locally relapsed. One- and 2-years OS were 94.8% and 90%, respectively. One- and 2-years DPFS were 47.8% and 30.8%, respectively, with a median DPFS of 11 months. Oligometastatic prostate cancer patients showed better polymetastases-free survival (PMFS) (P = 0.03) and DPFS (P = 0.008) than other histologies. Conclusions: Spinal SBRT is effective in treating spinal oligometastases. Dose boost could be safely administered to significantly improve LPFS. Prostate cancer patients showed better outcomes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
