Phase II study of high-dose photon/proton radiotherapy in the management of spine XXXX .

@entity1 @entity2828 @entity511 @entity137 @entity242 @entity6 @entity5 @entity16 @entity602 @entity421 @entity3580 @entity792
PURPOSE: Radiotherapy (XRT) for spine @entity242 is constrained by spinal cord, nerve, and viscera tolerance. Negative surgical margins are uncommon; hence, doses of >or=66 Gy are recommended. A Phase II clinical trial evaluated high-dose photon/proton XRT for spine @entity242 . METHODS AND MATERIALS: Eligible @entity1 had nonmetastatic, thoracic, lumbar, and/or sacral spine/paraspinal @entity242 . Treatment included pre- and/or postoperative photon/proton XRT with or without radical resection; @entity1 with @entity421 and @entity2828 received chemotherapy. Shrinking fields delivered 50.4 cobalt Gray equivalent (Gy RBE) to subclinical disease, 70.2 Gy RBE to microscopic disease in the @entity5 bed, and 77.4 Gy RBE to gross disease at 1.8 Gy RBE qd. Doses were reduced for radiosensitive histologies, concurrent chemoradiation, or when @entity6 or @entity792 present. Spinal cord dose was limited to 63/54 Gy RBE to surface/center. Intraoperative boost doses of 7.5 to 10 Gy could be given by dural plaque. RESULTS: A total of 50 @entity1 (29 @entity3580 , 14 @entity511 , 7 other) underwent gross total (n = 25) or subtotal (n = 12) resection or biopsy (n = 13). With 48 month median follow-up, 5-year actuarial local control, recurrence-free survival, and overall survival are: 78%, 63%, and 87% respectively. Two of 36 (5.6%) @entity1 treated for primary versus 7/14 (50%) for recurrent @entity5 developed local recurrence (p < 0.001). Five @entity1 developed late radiation-associated complications; no @entity602 developed but three sacral @entity16 appeared after 77.12 to 77.4 Gy RBE. CONCLUSIONS: Local control with this treatment is high in @entity1 radiated at the time of primary presentation. Spinal cord dose constraints appear to be safe. Sacral nerves receiving 77.12-77.4 Gy RBE are at risk for late @entity137 .
