Spine radiosurgery in adolescents and young adults: early outcomes and toxicity in patients with metastatic Ewing sarcoma and osteosarcoma

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OBJECTIVE

There are limited data on spine stereotactic radiosurgery (SRS) in treating adolescent and young adult (AYA) patients. SRS has the advantages of highly conformal radiation dose delivery in the upfront and retreatment settings, means for dose intensification, and administration over a limited number of sessions leading to a decreased treatment burden. In this study, the authors report the oncological and toxicity outcomes for AYA patients with metastatic sarcoma treated with spine radiosurgery and provide clinicians a guide for considerations in dose, volume, and fractionation.

METHODS

An institutional review board–approved database of patients treated with SRS in the period from October 2014 through December 2018 was queried. AYA patients, defined by ages 15–29 years, who had been treated with SRS for spine metastases from Ewing sarcoma or osteosarcoma were included in this analysis. Patients with follow-ups shorter than 6 months after SRS were excluded. Local control, overall survival, and toxicity were reported.

RESULTS

Seven patients with a total of 11 treated lesions were included in this study. Median patient age was 20.3 years (range 15.1–26.1 years). Three patients had Ewing sarcoma (6 lesions) and 4 patients had osteosarcoma (5 lesions). The median dose delivered was 35 Gy in 5 fractions (range 16–40 Gy, 1–5 fractions). The median follow-up was 11.1 months (range 6.8–26.0 months). Three local failures were observed within the follow-up period. No acute grade 3 or greater toxicity was observed. One patient developed late grade 3 toxicity consisting of radiation enteritis. This patient had previously received radiation to an overlapping volume with conventional fractionation. SRS re-irradiation for this patient was also performed concurrently with chemotherapy administration. No late grade 4 or higher toxicities were observed. No pain flare or vertebral compression fracture was observed. Three patients died within the follow-up period.

CONCLUSIONS

SRS for spine metastases from Ewing sarcoma and osteosarcoma can be considered as a treatment option in AYA patients and is associated with acceptable toxicity rates. Further studies must be conducted to determine long-term local control and toxicity for this treatment modality.

ABBREVIATIONS AYA = adolescent and young adult; BED = biologically effective dose; PTV = planning target volume; RTOG = Radiation Therapy Oncology Group; SRS = stereotactic radiosurgery.
Article Information

Contributor Notes

Correspondence Erin Murphy: Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH. murphye3@ccf.org.INCLUDE WHEN CITING Published online November 29, 2019; DOI: 10.3171/2019.9.SPINE19377.Disclosures Dr. Scott is a consultant for Cvergenx. Dr. Chao receives honorarium from Varian Medical Systems.
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