Copenhagen, Denmark
Onsite/Online

ESTRO 2022

Session Item

Mixed sites/palliation
6026
Poster (digital)
Clinical
The Dosimetric Analysis & Clinical Outcomes of Contiguous Vertebrae SBRT in Oligometastatic Patients
Ozan Cem Guler, Turkey
PO-1472

Abstract

The Dosimetric Analysis & Clinical Outcomes of Contiguous Vertebrae SBRT in Oligometastatic Patients
Authors:

Ozan Cem Guler1, Ezgi Oymak2, Cem Onal3

1Baskent University , Radiation Oncology, Adana, Turkey; 2Iskenderun Gelisim Hospital, Radiation Oncology, Iskenderun, Turkey; 3Baskent University, Radiation Oncology, Adana, Turkey

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Purpose or Objective

To evaluate the dosimetric analysis and clinical outcomes of patients undergoing single fraction spinal stereotactic body radiotherapy (SBRT) of 16-18 Gy for contiguous vertebrae.

Material and Methods

58 patients with oligometastatic primary and contiguous vertebral metastasis treated with SBRT for metastatic sites were retrospectively analyzed. All available imaging modalities were utilized. Target volumes were defined according to the International Spine Radiosurgery Consortium consensus. SBRT doses were 1x16 Gy or 1x 18 Gy according to the anatomic localization, extent of gross metastatic tumor and invading structure and dose constraints of neighboring structures. 

Results

The median tumor volume of the metastatic site treated with SBRT was 27.6±11.6 cc. Minimum dose (Dmin), maximum dose (Dmax) and mean dose (Dmean) for entire cohort were 14.18±1.02, 20.99±1.95 and 18.95±3.26, respectively. Spinal cord volume was 4.41±1.65. the maximum dose of spinal cord (Dmax), the dose to 0.35 cc of spinal cord (D0.35), the dose to 10% of the spinal cord (D10%) and the volume of spinal cord receiving 10 Gy (V10) were 11.68±0.85, 8.91±0.93, 8.53±0.87 and 0.14±0.11, respectively. When compared the CTV dosimetry according to SBRT dose there was no significant difference for 1x16 Gy or 1x18 Gy. Also, spinal cord dosimetry was not different for two groups. 

Half of the patients (29 pts, 50%) had breast cancer, 15 patients (25%) had prostate cancer, 5 patients (8%) had lung cancer and remaining 9 patients (17%) had various (rectum, cervical, gastric etc.) primaries. A total of 64 lesions were treated with SBRT in a total of 58 patients.  The SBRT doses were 1x16 Gy in majority of the patients (40 pts, 69%), and eighteen patients (31%) treated with 1x18 Gy. The median follow-up of entire cohort was 12 months (range, 1- 56 months). For the entire cohort, complete response (CR), partial response (PR) and progressed disease (PD) rates were 31%, 59% and 10%, respectively. Local recurrence was seen in ten patients (17%) within median 6 months after SBRT. The 1 and 2 year OS rates were 84% and 65%, respectively, and the 1 and 2 year PFS rates were 73% and 45%, respectively (Figure 2A and 2B). The 1 and 2 year LC rates were 81% and 70%, respectively (Figure 2C). We performed univariate analysis related with OS, PFS and LC. Patients with primary breast histology have better OS than other patients (24.3 vs. 13.9 months, p=0.024).  OS (18.7 vs. 38.8 months, p=0.013) and PFS (5.7 vs. 15.9 months, p<0.001) were worse in patients with recurrence ≤12 months. No patient experienced ≥grade 3 acute or late toxicity. 7 patients (12%) had grade 2, 10 had grade 1 toxicities.

Conclusion

SBRT is a non-invasive treatment method for spinal metastasis. Most of the data of contiguous vertebrae SBRT come from subgroups of spinal SBRT series and no homogenous series exist addressing the safety and toxicity. In this study, we present the efficacy and safety of 16-18 Gy SBRT to contiguous vertebrae.