Stereotactic Body Radiotherapy for Spinal Oligometastases With or Without Simultaneous Integrated Boost: Results From a Monocentric Retrospective Analysis

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology Pub Date : 2025-08-05 DOI:10.1016/j.clon.2025.103918

E. Pastorello , L. Nicosia , A.G. Allegra , C. De-Colle , N. Giaj-Levra , F. Ricchetti , M. Rigo , A. Romei , C. Orsatti , R. Ruggieri , F. Alongi

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引用次数: 0

Abstract

Aims

Radiotherapy has a known role in the treatment of symptomatic spinal bone metastases, but there is a relative paucity of data for ablative treatments. The aim of our study is to evaluate the efficacy and toxicity of stereotactic body radiotherapy (SBRT) in treating spinal oligometastases.

Methods

A series of spinal oligometastatic patients was treated between 2018 and 2023. The clinical target volume was defined according to Cox contouring guidelines. When feasible, a simultaneous integrated boost (SIB) was administered to the site of the macroscopic disease. The primary end-point was local progression-free survival (LPFS). Secondary objectives were toxicity, distant progression-free survival (DPFS), and overall survival (OS). The following covariates were evaluated: SIB, biologically effective dose, histology, number of total metastases (including both spinal and extra-spinal), and concurrent systemic therapy.

Results

One hundred and fifty-two spinal oligometastases in 120 patients were treated. Median follow-up was 22 months (range 6–72, with an interquartile range (IQR) of 21 months). Median dose was 24 Gy (range 21–30) delivered in 3 (3–5) fractions. The most common fractionation was 24 Gy in 3 fractions (49 metastases, 32.2%) SIB was administered in 33 metastases (21.7%). One-, and 2-year LPFS rates were 92.1% and 90%, respectively. Moreover, SIB resulted in a significantly improved 2-year LPFS (P = 0.037). Fourteen (9.2%) metastases locally relapsed.

One- and 2-years OS were 94.8% and 90%, respectively. One- and 2-years DPFS were 47.8% and 30.8%, respectively, with a median DPFS of 11 months. Oligometastatic prostate cancer patients showed better polymetastases-free survival (PMFS) (P = 0.03) and DPFS (P = 0.008) than other histologies.

Conclusions

Spinal SBRT is effective in treating spinal oligometastases. Dose boost could be safely administered to significantly improve LPFS. Prostate cancer patients showed better outcomes.

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立体定向放射治疗脊柱少转移瘤有或没有同步综合增强：来自单中心回顾性分析的结果

目的放疗在治疗有症状的脊柱骨转移中具有已知的作用，但消融治疗的数据相对缺乏。本研究的目的是评估立体定向放射治疗（SBRT）治疗脊柱少转移瘤的疗效和毒性。方法2018年至2023年，对一系列脊柱少转移患者进行治疗。根据Cox轮廓指南确定临床靶体积。在可行的情况下，同时对宏观疾病部位进行综合增强（SIB）。主要终点是局部无进展生存期（LPFS）。次要目标是毒性、远期无进展生存期（DPFS）和总生存期（OS）。评估了以下协变量：SIB，生物有效剂量，组织学，总转移数（包括脊柱和脊柱外）和并发全身治疗。结果120例脊柱少转移患者共152例得到治疗。中位随访时间为22个月（6-72个月，四分位数间距（IQR）为21个月）。中位剂量为24 Gy（范围21-30），分3（3 - 5）次递送。最常见的是3组24 Gy(49例，32.2%)；33例转移患者给予SIB（21.7%）。1年和2年的LPFS率分别为92.1%和90%。此外，SIB显著改善了2年LPFS （P = 0.037）。14例（9.2%）转移灶局部复发。1年OS为94.8%，2年OS为90%。1年和2年DPFS分别为47.8%和30.8%，中位DPFS为11个月。少转移性前列腺癌患者的无多转移生存期（PMFS）（P = 0.03）和DPFS （P = 0.008）均优于其他组织学。结论脊髓SBRT是治疗脊柱少转移瘤的有效方法。剂量增加可以安全地显著改善LPFS。前列腺癌患者表现出更好的结果。

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

Clinical oncology 医学-肿瘤学

CiteScore

5.20

自引率

8.80%

发文量

332

审稿时长

40 days

期刊介绍： Clinical Oncology is an International cancer journal covering all aspects of the clinical management of cancer patients, reflecting a multidisciplinary approach to therapy. Papers, editorials and reviews are published on all types of malignant disease embracing, pathology, diagnosis and treatment, including radiotherapy, chemotherapy, surgery, combined modality treatment and palliative care. Research and review papers covering epidemiology, radiobiology, radiation physics, tumour biology, and immunology are also published, together with letters to the editor, case reports and book reviews.