Journal article
A Phase 2 Clinical Trial of SABR Followed by Immediate Vertebroplasty for Spine Metastases
International journal of radiation oncology, biology, physics, Vol.104(1), pp.83-89
05/01/2019
DOI: 10.1016/j.ijrobp.2019.01.072
PMID: 30684664
Abstract
Purpose: To determine the pain response and prevention of vertebral compression fractures (VCFs) after single-fraction stereotactic ablative radiation therapy (SABR) in conjunction with immediate vertebroplasty for spine metastases.
Methods and Materials: Patients with localized spine metastases free from VCF associated with loss of vertebral height with a pain score >= 4 using the visual analog scale were enrolled. Spine SABR was performed with 20 Gy delivered to the gross disease and 14 Gy to the contiguous bone marrow in a single fraction Immediate, prophylactic vertebroplasty was performed within 1 month after spine SABR. The primary endpoint was pain response at 3 months compared to the historical control with external beam radiation therapy from Radiation Therapy Oncology Group study 9714. Secondary endpoints included pain response at 1 month, duration of pain response, vertebroplasty rate, VCF rate, local control, and overall survival.
Results: Thirty-five patients were enrolled, of whom 29 were deemed eligible and underwent single-fraction spine SABR. Twenty-three of these patients subsequently underwent prophylactic vertebroplasty. The 3-month pain response was significantly improved compared to Radiation Therapy Oncology Group study 9714: 95% versus 51% (P < .0001). The local control with a median follow-up of 9.6 months was 92%. The freedom from VCF was 90% at 1 year. Spine SABR was well tolerated with no grade 2 or higher toxicities. A single patient with disease extending from the vertebral body into the spinal canal developed vertebroplasty-related myelopathy, which was corrected with surgery.
Conclusions: Single-fraction SABR immediately followed by prophylactic vertebroplasty improves pain response compared with conventional radiation therapy while providing long-term pain control and structural stability of the treated spine. Vertebroplasty is well tolerated as a prophylactic measure in patients without loss of vertebral height after spine SABR. Pain response and VCF rates are similar to patients undergoing SABR alone. Thus, patients who would benefit most from the addition of vertebroplasty need to be further identified. (C) 2019 Elsevier Inc. All rights reserved.
Details
- Title: Subtitle
- A Phase 2 Clinical Trial of SABR Followed by Immediate Vertebroplasty for Spine Metastases
- Creators
- Zabi Wardak - The University of Texas Southwestern Medical CenterRoss Bland - The University of Texas Southwestern Medical CenterChul Ahn - The University of Texas Southwestern Medical CenterXian-Jin Xie - The University of Texas Southwestern Medical CenterDavid Chason - The University of Texas Southwestern Medical CenterKevin Morrill - The University of Texas Southwestern Medical CenterEdward Stehel - The University of Texas Southwestern Medical CenterLucien Nedzi - The University of Texas Southwestern Medical CenterChuxiong Ding - The University of Texas Southwestern Medical CenterPaul Medin - The University of Texas Southwestern Medical CenterThomas Boike - The University of Texas Southwestern Medical CenterRamzi Abdulrahman - The University of Texas Southwestern Medical CenterMichael Folkert - The University of Texas Southwestern Medical CenterPuneeth Iyengar - The University of Texas Southwestern Medical CenterNathan Kim - The University of Texas Southwestern Medical CenterHak Choy - The University of Texas Southwestern Medical CenterCarlos Bagley - The University of Texas Southwestern Medical CenterRobert Timmerman - The University of Texas Southwestern Medical Center
- Resource Type
- Journal article
- Publication Details
- International journal of radiation oncology, biology, physics, Vol.104(1), pp.83-89
- Publisher
- Elsevier
- DOI
- 10.1016/j.ijrobp.2019.01.072
- PMID
- 30684664
- ISSN
- 0360-3016
- eISSN
- 1879-355X
- Number of pages
- 7
- Language
- English
- Date published
- 05/01/2019
- Academic Unit
- Preventive and Community Dentistry; Biostatistics; Dental Research
- Record Identifier
- 9984367640102771
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