Prospective evaluation of spinal reirradiation by using stereotactic body radiation therapy: The University of Texas MD Anderson XXXX Center experience.

@entity1 @entity137 @entity5 @entity1161 @entity5300 @entity1745 @entity3 @entity158
BACKGROUND: Stereotactic body radiotherapy for previously irradiated, progressive spinal metastases may be a viable option in selected @entity1 . The authors review a prospective series of spinal @entity3 @entity1 reirradiated with stereotactic body radiotherapy. METHODS: A total of 59 @entity1 with 63 @entity5 of the spine were reirradiated with stereotactic body radiotherapy between 2003 and 2009. Spinal magnetic resonance imaging was performed both before treatment initiation and at regular follow-up intervals. Stereotactic body radiotherapy was delivered to a peripheral dose of 30 grays (Gy) in 5 fractions (6 Gy per fraction), or 27 Gy in 3 fractions (9 Gy per fraction). The National @entity5 Institute Common @entity137 Criteria 2.0 and McCormick neurological function system were used to evaluate @entity137 and neurologic status, respectively. RESULTS: Mean follow-up was 17.6 months. Actuarial 1-year radiographic local control and overall survival for all @entity1 were both 76%. Of the @entity5 that progressed after stereotactic body radiotherapy, 13 (81%) of 16 @entity1 had @entity5 that were within 5 mm of the spinal cord, and 6 of them eventually developed @entity1745 . @entity137 was most commonly grade 1 or 2 fatigue. Two @entity1 experienced mild to moderate @entity1161 ( @entity5300 ) while remaining independently ambulatory and @entity158 free. Freedom from neurologic deterioration from any cause was 92% at 1 year. CONCLUSIONS: Reirradiation for progressive spinal metastases with stereotactic body radiotherapy results in good local control and limited @entity137 . Initial surgery should be considered for @entity5 within 5 mm of the spinal cord. Radiation dose should be tailored for @entity5 near or invading the psoas muscle secondary to observed risk of @entity5300 .
