Resumen de Stereotactic body radiation therapy (SBRT) for spinal metastases: 12 years of a single center experience

Raquel Ciérvide Jurío, Ovidio Hernando Requejo, Mercedes López, Angel Montero, D. Zucca Aparicio, Emilio Sánchez Saugar, Beatriz Álvarez, Mariola García Aranda, Xin Chen Zhao, Jeannette Josefina Valero Albarrán, Rosa Alonso, Jaime Martí, Miguel Ángel de la Casa de Julián, Leyre Alonso Iracheta, Juan García, Paz Garcia de Acilu, Alejandro Prado, Pedro Fernández Letón, C. Rubio Rodríguez

• Objective To assess the clinical outcomes of patients with spine metastases treated with SBRT at our institution.

  Materials and methods Patients with spine metastases treated with SBRT (1 fraction/18 Gy or 5 fractions/7 Gy) during the last 12 years have been analyzed. All patients were simulated supine in a vacuum cushion or with a shoulder mask. CT scans and MRI image registration were performed. Contouring was based on International Spine-Radiosurgery-Consortium-Consensus-Guidelines. Highly conformal-techniques (IMRT/VMAT) were used for treatment planning. Intra and interfraction (CBCT or X-Ray-ExacTrac) verification were mandatory.

  Results From February 2010 to January 2022, 129 patients with spinal metastases were treated with SBRT [1 fraction/18 Gy (75%) or 5 fractions/7 Gy] (25%). For patients with painful metastases (74/129:57%), 100% experienced an improvement in pain after SBRT. With a median follow-up of 14.2 months (average 22.9; range 0.5–140) 6 patients (4.6%) experienced local relapse. Local progression-free survival was different, considering metastases’s location (p < 0.04). The 1, 2 and 3 years overall survival (OS) were 91.2%, 85.1% and 83.2%, respectively. Overall survival was significantly better for patients with spine metastases of breast and prostate cancers compared to other tumors (p < 0.05) and significantly worse when visceral metastases were present (p < 0.05), when patients were metastatic de novo (p < 0.05), and in those patients receiving single fraction SBRT (p: 0.01).

  Conclusions According to our experience, SBRT for patients with spinal metastases was effective in terms of local control and useful to reach pain relief. Regarding the intent of the treatment, an adequate selection of patients is essential to propose this ablative approach.