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Outcomes after palliative re-irradiation of spinal metastases

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

Radiotherapy (RT) effectively palliates symptomatic spinal metastases; however, both radiation myelopathy (RM) and disease progression are concerns following re-irradiation (re-RT). Limited published data suggest a low RM risk if the total biologically effective dose (BED) is ≤135.5 Gy, re-treatment interval is ≥6 months, and each course’s BED is ≤98 Gy. RM risk groups have been proposed; however, few data inform disease and RM outcomes after re-RT respecting these criteria. This study investigates these outcomes following re-RT for spinal metastases after publication of the aforementioned RM criteria.

Methods

Patients followed at a single institution after palliative spinal re-RT (C1-L2) from January 2008 to November 2013 were identified. Chart review assessed RM criteria, risk groups, and disease progression. BEDs were calculated using the linear quadratic model.

Results

Fifty-three patients underwent re-RT to a median cumulative BED of 126.8 Gy (range 48.0–157.8) with a median re-treatment interval of 19.3 months (range 1.0–197.6). No courses had a BED ≥98 Gy. After a median follow-up of 4.1 months (range 0.2–124.9) for all (n = 53) and 11.5 months (range 1.6–29.4) for surviving (n = 12) patients, no RM was observed. The median survival following re-RT was 5.5 months (range 0.5–125.3). Fourteen patients progressed locally (14/53; 26.4 %); all developed varying degrees of irreversible neurologic injury.

Conclusion

Patients undergoing re-RT for spinal metastases have a poor prognosis. No RM was observed after re-RT largely respecting published low-risk criteria. Neurologic injury from progression was common. Further study of exceeding the low-risk criteria, particularly among poor prognosis patients, may be warranted.

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Acknowledgments

This study received the following financial support for the research, authorship, and/or publication of this article: American Society of Clinical Oncology Conquer Cancer Foundation Career Development Award (T.A.B...).

Conflict of interest

Matthew D. Cheney, M.D., Ph.D., Tai-Chung Lam, M.D., Hajime Uno, Ph.D., Barbara A. Jaehn, B.S., Antonio L. Damato, Ph.D., Monica Krishnan, M.D., and Tracy A. Balboni, M.D., M.P.H., confirm that they have no conflicts of interest.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 as revised in 2008. Informed consent was obtained from all patients included in the study.

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Authors and Affiliations

  1. Harvard Radiation Oncology Program, Boston, MA, USA

    Matthew D. Cheney

  2. Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, ASBI/L2 75 Francis St., Boston, MA, 02115, USA

    Matthew D. Cheney, Tai-Chung Lam, Barbara A. Jaehn, Antonio L. Damato, Monica S. Krishnan & Tracy A. Balboni

  3. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    Hajime Uno

  4. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Hajime Uno

  5. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA

    Tracy A. Balboni

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  1. Matthew D. Cheney
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Correspondence to Matthew D. Cheney.

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Cheney, M.D., Lam, TC., Uno, H. et al. Outcomes after palliative re-irradiation of spinal metastases. J Radiat Oncol 4, 157–162 (2015). https://doi.org/10.1007/s13566-015-0192-9

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  • DOI: https://doi.org/10.1007/s13566-015-0192-9

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