Patient outcomes and tumor control in single-fraction versus hypofractionated stereotactic body radiation therapy for spinal metastases

Presented at the 2020 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

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  • 1 Departments of Neurosurgery and
  • 2 Radiation Oncology, Duke University Medical Center; and
  • 3 Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Durham, North Carolina
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OBJECTIVE

Stereotactic body radiation therapy (SBRT) offers efficient, noninvasive treatment of spinal neoplasms. Single-fraction (SF) high-dose SBRT has a relatively narrow therapeutic window, while hypofractionated delivery of SBRT may have an improved safety profile with similar efficacy. Because the optimal approach of delivery is unknown, the authors examined whether hypofractionated SBRT improves pain and/or functional outcomes and results in better tumor control compared with SF-SBRT.

METHODS

This is a single-institution retrospective study of adult patients with spinal metastases treated with SF- or three-fraction (3F) SBRT from 2008 to 2019. Demographics and baseline characteristics, radiographic data, and posttreatment outcomes at a minimum follow-up of 3 months are reported.

RESULTS

Of the 156 patients included in the study, 70 (44.9%) underwent SF-SBRT (median total dose 1700 cGy) and 86 (55.1%) underwent 3F-SBRT (median total dose 2100 cGy). At baseline, a higher proportion of patients in the 3F-SBRT group had a worse baseline profile, including severity of pain (p < 0.05), average use of pain medication (p < 0.001), and functional scores (p < 0.05) compared with the SF-SBRT cohort. At the 3-month follow-up, the 3F-SBRT cohort experienced a greater frequency of improvement in pain compared with the SF-SBRT group (p < 0.05). Furthermore, patients treated with 3F-SBRT demonstrated a higher frequency of improved Karnofsky Performance Scale (KPS) scores (p < 0.05) compared with those treated with SF-SBRT, with no significant difference in the frequency of improvement in modified Rankin Scale scores. Local tumor control did not differ significantly between the two cohorts.

CONCLUSIONS

Patients who received spinal 3F-SBRT more frequently achieved significant pain relief and an increased frequency of improvement in KPS compared with those treated with SF-SBRT. Local tumor control was similar in the two groups. Future work is needed to establish the relationship between fractionation schedule and clinical outcomes.

ABBREVIATIONS BED = biologically effective dose; KPS = Karnofsky Performance Scale; mRS = modified Rankin Scale; OMED = oral morphine equivalent dosing; PTV = planning target volume; RT = radiation therapy; SBRT = stereotactic body RT; SF-SBRT = single-fraction SBRT; SRS = stereotactic radiosurgery; VCF = vertebral compression fracture; 3F-SBRT = three-fraction SBRT.

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Contributor Notes

Correspondence C. Rory Goodwin: Duke University Medical Center, Durham, NC. spineresearch@dm.duke.edu.

INCLUDE WHEN CITING Published online November 6, 2020; DOI: 10.3171/2020.6.SPINE20349.

Disclosures Dr. Kirkpatrick: principal and owner of ClearSight RT, LLC and research funding from Varian Medical Systems. Dr. Abd-El-Barr: consultant for Spineology. Dr. Karikari: consultant for NuVasive, DePuy, and Globus and spine fellowship fund from NuVasive.

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