Spine stereotactic body radiotherapy for renal cell cancer spinal metastases: analysis of outcomes and risk of vertebral compression fracture

Clinical article

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  • 1 Department of Radiation Oncology, Sunnybrook Odette Cancer Centre; 
  • 2 Departments of Radiation Oncology and
  • 3 Biostatistics, Princess Margaret Cancer Centre;
  • 4 Department of Orthopaedic Surgery, Sunnybrook Health Sciences Centre;
  • 5 Division of Neurosurgery and Spinal Program, Toronto Western Hospital; and
  • 6 Department of Medical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Ontario, Canada
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Object

The aim of this study was to evaluate local control (LC) and the risk of vertebral compression fracture (VCF) after stereotactic body radiotherapy (SBRT) in patients with renal cell cancer spinal metastases.

Methods

Prospectively collected data on 71 spinal segments treated with SBRT in 37 patients were reviewed. The median follow-up was 12.3 months (range 1.2–55.4 months). The LC rate was assessed based on each spinal segment treated and overall survival (OS) according to each patient treated. Sixty of 71 segments (85%) were radiation naive, 11 of 71 (15%) were previously irradiated, and 10 of 71 (14%) were treated with postoperative SBRT. The median SBRT total dose and number of fractions were 24 Gy and 2, respectively. The VCF analysis also included evaluation of the Spinal Instability Neoplastic Score criteria.

Results

The 1-year OS and LC rates were 64% and 83%, respectively. Multivariate analysis identified oligometastatic disease (13 of 37 patients) as a positive prognostic factor (p = 0.018) for OS. Of 61 non-postoperative spinal segments treated, 10 (16%) developed VCFs; 3 of 10 were de novo VCFs and 7 of 10 occurred as progression of an existing VCF. The 1-year VCF-free probability rate was 82%. Multivariate analysis identified single-fraction SBRT and baseline VCF as significant predictors of SBRT-induced VCF (p = 0.028 and p = 0.012, respectively).

Conclusions

Spine SBRT yields high rates of local tumor control in patients with renal cell cancer. Baseline VCF and 18–24 Gy delivered in a single fraction were predictive of further collapse. Patients with oligometastatic disease may benefit most from such aggressive local therapy, given the prolonged survival observed.

Abbreviations used in this paper:ASIA = American Spinal Injury Association; CBCT = cone-beam CT; CTV = clinical target volume; HR = hazard ratio; LC = local control; OS = overall survival; PRV = planning organ at risk volume; PTV = planning target volume; RCC = renal cell cancer; SBRT = stereotactic body radiotherapy; SINS = Spinal Instability Neoplastic Score; VCF = vertebral compression fracture.

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Contributor Notes

Address correspondence to: Arjun Sahgal, M.D., Department of Radiation Oncology, Sunnybrook Health Sciences Centre and the Princess Margaret Cancer Centre, University of Toronto, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada. email: arjun.sahgal@sunnybrook.ca.

Please include this information when citing this paper: published online August 29, 2014; DOI: 10.3171/2014.7.SPINE13895.

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