TY - JOUR
T1 - Stereotactic Body Radiation Therapy for Spinal Metastases
T2 - Tumor Control Probability Analyses and Recommended Reporting Standards
AU - Soltys, Scott G.
AU - Grimm, Jimm
AU - Milano, Michael T.
AU - Xue, Jinyu
AU - Sahgal, Arjun
AU - Yorke, Ellen
AU - Yamada, Yoshiya
AU - Ding, George X.
AU - Li, X. Allen
AU - Lovelock, D. Michael
AU - Jackson, Andrew
AU - Ma, Lijun
AU - El Naqa, Issam
AU - Gibbs, Iris C.
AU - Marks, Lawrence B.
AU - Benedict, Stanley
N1 - Funding Information:
Disclosures: S.G.S. is a consultant for Inovio Pharmaceuticals, Inc.; receives speaker honoraria for Zap Surgical, Inc.; and receives research funding from Novocure. J.G. receives research grants from Accuray and NovoCure and has a DVH evaluator patent. M.T.M. receives royalties from Wolters Kluwer; and personal fees from Galera Therapeutics. A.S. is an advisor/consultant with AbbVie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (Medical Advisory Board); is a board member of International Stereotactic Radiosurgery Society (ISRS); is a co-chair of AO Spine Knowledge Forum Tumor; gave past educational seminars for Elekta AB, Accuray Inc, Varian (Congress of Neurological Surgeons Teaching Faculty), BrainLAB, Medtronic Kyphon; receives research grant from Elekta AB; receives travel accommodations/expenses from Elekta, Varian, BrainLAB; and belongs to the Elekta MR Linac Research Consortium, Elekta Spine, Oligometastases and Linac Based SRS Consortia. E.Y. receives support from National Institutes of Health grants R01 CA129182 and P30 CA008748. A.J receives support from National Institutes of Health grants R01 CA129182 and P30 CA008748. Y.Y. is a consultant for Varian Medical Systems, BrainLab, Vision RT, and the University of Wollongong; Medical Advisory Board for the Chordoma Foundation. X.A.L. receives grants from Elekta, Siemens, and Manteia Med. D.M.L. receives support from National Institutes of Health grants R01 CA129182 and P30 CA008748. A.J. receives grants from the National Institutes of Health. I.E.N. is on the Scientific advisory board of Endectra; and receives grants from the National Institutes of Health. I.G. receives speaker’s honoraria from Accuray, Inc.
Funding Information:
Disclosures: S.G.S. is a consultant for Inovio Pharmaceuticals, Inc.; receives speaker honoraria for Zap Surgical, Inc.; and receives research funding from Novocure. J.G. receives research grants from Accuray and NovoCure and has a DVH evaluator patent. M.T.M. receives royalties from Wolters Kluwer; and personal fees from Galera Therapeutics. A.S. is an advisor/consultant with AbbVie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (Medical Advisory Board); is a board member of International Stereotactic Radiosurgery Society (ISRS); is a co-chair of AO Spine Knowledge Forum Tumor; gave past educational seminars for Elekta AB, Accuray Inc, Varian (Congress of Neurological Surgeons Teaching Faculty), BrainLAB, Medtronic Kyphon; receives research grant from Elekta AB; receives travel accommodations/expenses from Elekta, Varian, BrainLAB; and belongs to the Elekta MR Linac Research Consortium, Elekta Spine, Oligometastases and Linac Based SRS Consortia. E.Y. receives support from National Institutes of Health grants R01 CA129182 and P30 CA008748. A.J receives support from National Institutes of Health grants R01 CA129182 and P30 CA008748. Y.Y. is a consultant for Varian Medical Systems, BrainLab, Vision RT, and the University of Wollongong; Medical Advisory Board for the Chordoma Foundation. X.A.L. receives grants from Elekta, Siemens, and Manteia Med. D.M.L. receives support from National Institutes of Health grants R01 CA129182 and P30 CA008748. A.J. receives grants from the National Institutes of Health. I.E.N. is on the Scientific advisory board of Endectra; and receives grants from the National Institutes of Health. I.G. receives speaker's honoraria from Accuray, Inc.
PY - 2021
Y1 - 2021
N2 - Purpose: We sought to investigate the tumor control probability (TCP) of spinal metastases treated with stereotactic body radiation therapy (SBRT) in 1 to 5 fractions. Methods and Materials: PubMed-indexed articles from 1995 to 2018 were eligible for data extraction if they contained SBRT dosimetric details correlated with actuarial 2-year local tumor control rates. Logistic dose-response models of collected data were compared in terms of physical dose and 3-fraction equivalent dose. Results: Data were extracted from 24 articles with 2619 spinal metastases. Physical dose TCP modeling of 2-year local tumor control from the single-fraction data were compared with data from 2 to 5 fractions, resulting in an estimated α/β = 6 Gy, and this was used to pool data. Acknowledging the uncertainty intrinsic to the data extraction and modeling process, the 90% TCP corresponded to 20 Gy in 1 fraction, 28 Gy in 2 fractions, 33 Gy in 3 fractions, and (with extrapolation) 40 Gy in 5 fractions. The estimated TCP for common fractionation schemes was 82% at 18 Gy, 90% for 20 Gy, and 96% for 24 Gy in a single fraction, 82% for 24 Gy in 2 fractions, and 78% for 27 Gy in 3 fractions. Conclusions: Spinal SBRT with the most common fractionation schemes yields 2-year estimates of local control of 82% to 96%. Given the heterogeneity in the tumor control estimates extracted from the literature, with variability in reporting of dosimetry data and the definition of and statistical methods of reporting tumor control, care should be taken interpreting the resultant model-based estimates. Depending on the clinical intent, the improved TCP with higher dose regimens should be weighed against the potential risks for greater toxicity. We encourage future reports to provide full dosimetric data correlated with tumor local control to allow future efforts of modeling pooled data.
AB - Purpose: We sought to investigate the tumor control probability (TCP) of spinal metastases treated with stereotactic body radiation therapy (SBRT) in 1 to 5 fractions. Methods and Materials: PubMed-indexed articles from 1995 to 2018 were eligible for data extraction if they contained SBRT dosimetric details correlated with actuarial 2-year local tumor control rates. Logistic dose-response models of collected data were compared in terms of physical dose and 3-fraction equivalent dose. Results: Data were extracted from 24 articles with 2619 spinal metastases. Physical dose TCP modeling of 2-year local tumor control from the single-fraction data were compared with data from 2 to 5 fractions, resulting in an estimated α/β = 6 Gy, and this was used to pool data. Acknowledging the uncertainty intrinsic to the data extraction and modeling process, the 90% TCP corresponded to 20 Gy in 1 fraction, 28 Gy in 2 fractions, 33 Gy in 3 fractions, and (with extrapolation) 40 Gy in 5 fractions. The estimated TCP for common fractionation schemes was 82% at 18 Gy, 90% for 20 Gy, and 96% for 24 Gy in a single fraction, 82% for 24 Gy in 2 fractions, and 78% for 27 Gy in 3 fractions. Conclusions: Spinal SBRT with the most common fractionation schemes yields 2-year estimates of local control of 82% to 96%. Given the heterogeneity in the tumor control estimates extracted from the literature, with variability in reporting of dosimetry data and the definition of and statistical methods of reporting tumor control, care should be taken interpreting the resultant model-based estimates. Depending on the clinical intent, the improved TCP with higher dose regimens should be weighed against the potential risks for greater toxicity. We encourage future reports to provide full dosimetric data correlated with tumor local control to allow future efforts of modeling pooled data.
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U2 - 10.1016/j.ijrobp.2020.11.021
DO - 10.1016/j.ijrobp.2020.11.021
M3 - Article
AN - SCOPUS:85100092459
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
SN - 0360-3016
ER -