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

Publication ,  Journal Article
Park, C; Howell, EP; Mehta, VA; Ramirez, L; Price, MJ; Floyd, SR; Kirkpatrick, JP; Torok, J; Abd-El-Barr, MM; Karikari, IO; Goodwin, CR
Published in: J Neurosurg Spine
November 6, 2020

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.

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Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

November 6, 2020

Volume

34

Issue

2

Start / End Page

293 / 302

Location

United States

Related Subject Headings

  • Orthopedics
  • 3209 Neurosciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Park, C., Howell, E. P., Mehta, V. A., Ramirez, L., Price, M. J., Floyd, S. R., … Goodwin, C. R. (2020). Patient outcomes and tumor control in single-fraction versus hypofractionated stereotactic body radiation therapy for spinal metastases. J Neurosurg Spine, 34(2), 293–302. https://doi.org/10.3171/2020.6.SPINE20349
Park, Christine, Elizabeth P. Howell, Vikram A. Mehta, Luis Ramirez, Meghan J. Price, Scott R. Floyd, John P. Kirkpatrick, et al. “Patient outcomes and tumor control in single-fraction versus hypofractionated stereotactic body radiation therapy for spinal metastases.J Neurosurg Spine 34, no. 2 (November 6, 2020): 293–302. https://doi.org/10.3171/2020.6.SPINE20349.
Park C, Howell EP, Mehta VA, Ramirez L, Price MJ, Floyd SR, et al. Patient outcomes and tumor control in single-fraction versus hypofractionated stereotactic body radiation therapy for spinal metastases. J Neurosurg Spine. 2020 Nov 6;34(2):293–302.
Park, Christine, et al. “Patient outcomes and tumor control in single-fraction versus hypofractionated stereotactic body radiation therapy for spinal metastases.J Neurosurg Spine, vol. 34, no. 2, Nov. 2020, pp. 293–302. Pubmed, doi:10.3171/2020.6.SPINE20349.
Park C, Howell EP, Mehta VA, Ramirez L, Price MJ, Floyd SR, Kirkpatrick JP, Torok J, Abd-El-Barr MM, Karikari IO, Goodwin CR. Patient outcomes and tumor control in single-fraction versus hypofractionated stereotactic body radiation therapy for spinal metastases. J Neurosurg Spine. 2020 Nov 6;34(2):293–302.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

November 6, 2020

Volume

34

Issue

2

Start / End Page

293 / 302

Location

United States

Related Subject Headings

  • Orthopedics
  • 3209 Neurosciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences