Dose-intensified SBRT for vertebral oligometastases: results from a prospective clinical trial

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-05-14 DOI:10.1016/j.radonc.2025.110940

Matthias Guckenberger , Lotte Wilke , Charlotte Billiet , Susanne Rogers , Ciro Franzese , Daniel Schnell , Mateusz Spałek , Daniel M. Aebersold , Hossein Hemmatazad , Thomas Zilli , Judit Boda-Heggemann , Brigitta G. Baumert , Jean-Jacques Stelmes , Franziska Nägler , Philipp Gut , Christian Weiß , Alessio Bruni , Frank Zimmermann , Robert Förster , Jörg Zimmer , Indira Madani

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引用次数: 0

Abstract

Purpose

To prospectively evaluate safety and efficacy of dose-intensified multifraction SBRT using a simultaneous-integrated boost concept for vertebral oligometastases.

Material and Methods

Data from 128 patients with 143 vertebral oligometastases (≤5 distant metastases in total) treated with dose-intensified SBRT (48.5 Gy/10 [with epidural involvement] or 40 Gy/5 [without epidural involvement]) in the randomized and non-randomized arms of a phase 3 clinical trial conducted at 18 international centers between 2016 and 2023 were analyzed.

Results

The median age of all patients was 68 years; 77 patients (60.2%) had breast and prostate cancer. Of 143 vertebral metastases, 23 (16.1%) and 22 metastases (15.4%) had epidural and paraspinal tumor involvement, respectively. The median follow-up time was 24 months. At 2 years, cumulative incidence of local failure (4 failures) was 5.3%. There were 4 (2.8%) baseline and 8 (5.6%) de novo vertebral compression fractures (VCFs). Two-year OS was 82.2% (95% CI, 74.9–89.6%). There was no grade ≥ 4 adverse events (AE) and the crude rate of grade 3 AEs was 5.5%; no myelopathy or plexopathy was observed. On multivariate analysis, only non-breast or non-prostate cancer (HR, 7.91; 95%, CI 1.79–35.03; 2-sided P = 0.01) were found to be prognostic for adverse OS. No prognostic factors for VCF were identified. Epidural and paraspinal involvement were not found to be prognostic for treatment outcome.

Conclusions

Dose-intensified SBRT for vertebral oligometastases is effective and safe, even in high-risk patients with epidural or paraspinal involvement.

查看原文本刊更多论文

椎体少转移瘤的剂量强化SBRT：一项前瞻性临床试验的结果。

目的：前瞻性评估剂量强化多组分SBRT治疗椎体少转移瘤的安全性和有效性。材料和方法：我们分析了2016年至2023年在18个国际中心进行的一项3期临床试验的随机组和非随机组中，128例椎体少转移患者（共≤5例远处转移）接受剂量强化SBRT治疗（48.5 Gy/10[硬膜外受损伤]或40 Gy/5[无硬膜外受损伤]）的数据。结果：所有患者的中位年龄为68 岁；77例（60.2 %）有乳腺癌和前列腺癌。143例椎体转移中，23例（16.1 %）和22例（15.4 %）分别累及硬膜外和脊柱旁肿瘤。中位随访时间为24 个月。在2 年，局部失败的累积发生率（4例）为5. %。有4例（2.8 %）基线和8例（5.6 %）新发椎体压缩性骨折（vcf）。2年OS为82.2 %（95 % CI, 74.9 ~ 89.6 %）。无 ≥ 4级不良事件（AE）， 3级AE粗发生率为5.5% %；未见脊髓病或神经丛病。在多变量分析中，只有非乳腺癌或非前列腺癌(HR, 7.91；95 %,ci 1.79-35.03；双侧P = 0.01)是不良OS的预后因素。没有确定VCF的预后因素。硬膜外和脊髓旁受累不影响治疗结果。结论：剂量强化SBRT治疗椎体少转移瘤是有效和安全的，即使在硬膜外或脊柱旁受累的高危患者中也是如此。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.