Experience of stereotactic radiation therapy and radiosurgical treatment of metastatic vertebral tumors

Purpose of the study. Evaluation of the effectiveness of extracranial stereotactic radiation therapy in various fractionation regimens in the treatment of patients with metastatic vertebral lesions.

Patients and methods. The study included 12 patients with metastatic spinal lesions who underwent extracranial stereotactic radiation therapy (SBRT) on a Novalis Tx linear accelerator, Varian, in radiosurgery mode (SRS; in 1 fraction) and hypofractionation mode (SFD 5Gy, TFD 25Gy, 5 fractions) in the period from 01/01/2020 to 03/31/2022. The assessment of local control was carried out using positron emission tomography – computed tomography (PET-CT) from 18FDG. The intensity of the pain syndrome before and after radiation was assessed using a visual analog pain scale (VAS).

Results. 19 vertebrae with metastatic lesions were irradiated in 12 patients. The SBRT technique in hypofractionation mode was used in 6 (50 %) patients, in radiosurgery (SRS) mode was used in 4 (34 %) patients, in 2 (17 %) patients a combination of irradiation techniques was used on various affected segments of the spinal column. The general tumor volume (GTV) averaged 30.56 = 7.8 km². When using the radiosurgical irradiation regimen, SFD ranged from 16 to 18 Gy. When using the hypofractionation technique, the total focal dose (TFD) was 25 Gy, a single focal dose (SFD) was 5 Gy.

Conclusion. Stereotactic radiation therapy and radiosurgery of metastatic vertebral tumors without compression of neural structures provides local tumor control in 92 % of patients within 6 months and in 83 % of patients within 1 year, regression of pain after irradiation – in 67 % of patients.

1. Zaborovsky NS, Ptashnikov DA, Topuzov EE, Levchenko EV, Mikhailov DA, Natalenko KE. Spine tumor epidemiology in patients who underwent orthopaedic surgery. Traumatology and Orthopedics of Russia. 2019;25(1):104–112. (In Russ.). https://doi.org/10.21823/2311-2905-2019-25-1-104-112, EDN: ZELXRB

2. Аrseniev AI, Kanaev SV, Novikov SN, Barchuk AA, Ponomareva OI, Antipov PhE, et al. Stereotactic radiation therapy in the treatment of primary and metastatic tumor lesions of the spine. Voprosy Onkologii. 2022;68(4):413–426. (In Russ.). https://doi.org/10.37469/0507-3758-2022-68-4-413-426, EDN: EYPWKT

3. Golanov AV, Gorlachev GE, Antipina NA, Konovalov NA, Shevelev IN, Vetlova ER, et al. Cyberknife stereotactic radiotherapy for mass lesions of spinal cord and spine. Zhurnal Voprosy Burdenko's Journal of Neurosurgery. 2012;76(1):54-63. (In Russ.). EDN: PDXHUL

4. Cox BW, Spratt DE, Lovelock M, Bilsky MH, Lis E, Ryu S, et al. International Spine Radiosurgery Consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2012 Aug 1;83(5):e597-605. https://doi.org/10.1016/j.ijrobp.2012.03.009

5. Heron DE, Saiful Huq M, Herman JM. Stereotactic radiosurgery and stereotactic body radiation therapy (SBRT). Vargo JA, Mihai А, Engh JA et al. Spine SBRT. New York: Demos, 2018:279–292.

6. Sprave T, Verma V, Förster R, Schlampp I, Bruckner T, Bostel T, et al. Randomized phase II trial evaluating pain response in patients with spinal metastases following stereotactic body radiotherapy versus three-dimensional conformal radiotherapy. Radiother Oncol. 2018 Aug;128(2):274–282. https://doi.org/10.1016/j.radonc.2018.04.030

7. Ryu S, Deshmukh S, Timmerman R, Movsas B, Gerszten P, Yin F, et al. Radiosurgery Compared To External Beam Radiotherapy for Localized Spine Metastasis: Phase III Results of NRG Oncology/RTOG 0631. Int J Radiat Oncol Biol Phys. 2019 Aug 1;105(1):S2–3.

8. A, Myrehaug SD, Siva S, Masucci GL, Maralani PJ, Brundage M, et al. Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trial. Lancet Oncol. 2021 Jul;22(7):1023–1033. https://doi.org/10.1016/S1470-2045(21)00196-0

9. Singh R, Lehrer EJ, Dahshan B, Palmer JD, Sahgal A, Gerszten PC, et al. Single fraction radiosurgery, fractionated radiosurgery, and conventional radiotherapy for spinal oligometastasis (SAFFRON): A systematic review and meta-analysis. Radiother Oncol. 2020 May;146:76–89. https://doi.org/10.1016/j.radonc.2020.01.030