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Original article
peer-reviewed

Spine Stereotactic Body Radiotherapy Outcomes in Patients with Concurrent Brain Metastases



Abstract

Objectives: Stereotactic body radiotherapy (SBRT) is an emerging technique for maximizing tumor and pain control in selected patients with spinal metastases. Outcomes for those with concurrent brain metastases (CBM) have not been well-described previously. The goal of this study was to compare outcomes for patients with or without CBM treated with spine SBRT.

Methods: Records of all patients treated with SBRT for spine metastases at our institution from January 2008 to January 2014 were reviewed. Chi-square analyses and the Mann-Whitney test were used to assess the association of CBM (defined as brain metastasis present prior to or at the time of spinal SBRT) with potential covariates. The log-rank test and Cox proportional hazards regression were used to evaluate the impact of CBM on overall survival and local control from the time of the first course of spine SBRT.

Results: Seventy-eight patients and a total of 86 SBRT lesions were treated. Median patient age was 60 years (range: 38-84 years); 28.2% had radioresistant histologies. A single fraction was used in 91.0% of treatments. One-year local control was 89.4%, and one-year overall survival was 45.8%. A total of 19 patients (24.4%) had CBM. Among these CBM patients, 18 (94.7%) underwent intracranial radiosurgery and nine (47.4%) were diagnosed synchronously with their spine metastases. Local control was not significantly different between patients with or without CBM on univariable (median: 58 months vs. not reached, p = 0.53) or multivariable analyses (HR 0.52, 95% CI 0.06-4.33). Overall survival was also not significantly different between patients with or without CBM on univariable (median: 7 vs. 11 months, log-rank p = 0.12) or multivariable analyses (HR 1.62, 95% CI 0.87-3.03).

Conclusions: Patients with CBM do not appear to have a statistically significant detriment in clinical outcomes, suggesting that CBM should not necessarily be considered a contraindication for spine SBRT. Although our study is limited by significant heterogeneity in tumor type within our series, future work should focus on the development of reliable survival prognosticators for patients undergoing spinal radiosurgery. Nearly half of the patients with CBM were diagnosed synchronously with their spine metastases, emphasizing the usefulness of obtaining a brain MRI for complete staging prior to spine SBRT.



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Original article
peer-reviewed

Spine Stereotactic Body Radiotherapy Outcomes in Patients with Concurrent Brain Metastases


Author Information

Rovel J. Colaco Corresponding Author

Therapeutic Radiology, Yale University

Henry S. Park

Therapeutic Radiology, Yale University

Maxwell S. Laurans

Neurosurgery, Yale University

Veronica S. Chiang

Neurosurgery, Yale University

James B. Yu

Radiation Oncology, Yale University

Zain A. Husain

Therapeutic Radiology, Yale University


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Yale University Institutional Review Board issued approval 1112009443. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: James B Yu declare(s) a grant from 21st Century Oncology. Dr. Yu receives research funding from 21st Century Oncology. These funding sources had no involvement in the design, analysis, or preparation of the manuscript. . James B Yu declare(s) a grant from PhRMA Foundation. Dr. Yu received research funding from the PhRMA Foundation. These funding sources had no involvement in the design, analysis, or preparation of the manuscript. . Henry S Park declare(s) personal fees from Varian. Dr. Park received honoraria and travel expenses from Varian Medical Systems. This funding source had no involvement in the design, analysis, or preparation of the manuscript.

Acknowledgements

Drs. Rovel J Colaco and Henry S Park contributed equally as first co-authors to this work


Original article
peer-reviewed

Spine Stereotactic Body Radiotherapy Outcomes in Patients with Concurrent Brain Metastases


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Original article
peer-reviewed

Spine Stereotactic Body Radiotherapy Outcomes in Patients with Concurrent Brain Metastases

  • Author Information
    Rovel J. Colaco Corresponding Author

    Therapeutic Radiology, Yale University

    Henry S. Park

    Therapeutic Radiology, Yale University

    Maxwell S. Laurans

    Neurosurgery, Yale University

    Veronica S. Chiang

    Neurosurgery, Yale University

    James B. Yu

    Radiation Oncology, Yale University

    Zain A. Husain

    Therapeutic Radiology, Yale University


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Yale University Institutional Review Board issued approval 1112009443. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: James B Yu declare(s) a grant from 21st Century Oncology. Dr. Yu receives research funding from 21st Century Oncology. These funding sources had no involvement in the design, analysis, or preparation of the manuscript. . James B Yu declare(s) a grant from PhRMA Foundation. Dr. Yu received research funding from the PhRMA Foundation. These funding sources had no involvement in the design, analysis, or preparation of the manuscript. . Henry S Park declare(s) personal fees from Varian. Dr. Park received honoraria and travel expenses from Varian Medical Systems. This funding source had no involvement in the design, analysis, or preparation of the manuscript.

    Acknowledgements

    Drs. Rovel J Colaco and Henry S Park contributed equally as first co-authors to this work


    Article Information

    Published: July 11, 2016

    DOI

    10.7759/cureus.679

    Cite this article as:

    Colaco R J, Park H S, Laurans M S, et al. (July 11, 2016) Spine Stereotactic Body Radiotherapy Outcomes in Patients with Concurrent Brain Metastases. Cureus 8(7): e679. doi:10.7759/cureus.679

    Publication history

    Received by Cureus: May 03, 2016
    Peer review began: May 27, 2016
    Peer review concluded: June 23, 2016
    Published: July 11, 2016

    Copyright

    © Copyright 2016
    Colaco et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Objectives: Stereotactic body radiotherapy (SBRT) is an emerging technique for maximizing tumor and pain control in selected patients with spinal metastases. Outcomes for those with concurrent brain metastases (CBM) have not been well-described previously. The goal of this study was to compare outcomes for patients with or without CBM treated with spine SBRT.

Methods: Records of all patients treated with SBRT for spine metastases at our institution from January 2008 to January 2014 were reviewed. Chi-square analyses and the Mann-Whitney test were used to assess the association of CBM (defined as brain metastasis present prior to or at the time of spinal SBRT) with potential covariates. The log-rank test and Cox proportional hazards regression were used to evaluate the impact of CBM on overall survival and local control from the time of the first course of spine SBRT.

Results: Seventy-eight patients and a total of 86 SBRT lesions were treated. Median patient age was 60 years (range: 38-84 years); 28.2% had radioresistant histologies. A single fraction was used in 91.0% of treatments. One-year local control was 89.4%, and one-year overall survival was 45.8%. A total of 19 patients (24.4%) had CBM. Among these CBM patients, 18 (94.7%) underwent intracranial radiosurgery and nine (47.4%) were diagnosed synchronously with their spine metastases. Local control was not significantly different between patients with or without CBM on univariable (median: 58 months vs. not reached, p = 0.53) or multivariable analyses (HR 0.52, 95% CI 0.06-4.33). Overall survival was also not significantly different between patients with or without CBM on univariable (median: 7 vs. 11 months, log-rank p = 0.12) or multivariable analyses (HR 1.62, 95% CI 0.87-3.03).

Conclusions: Patients with CBM do not appear to have a statistically significant detriment in clinical outcomes, suggesting that CBM should not necessarily be considered a contraindication for spine SBRT. Although our study is limited by significant heterogeneity in tumor type within our series, future work should focus on the development of reliable survival prognosticators for patients undergoing spinal radiosurgery. Nearly half of the patients with CBM were diagnosed synchronously with their spine metastases, emphasizing the usefulness of obtaining a brain MRI for complete staging prior to spine SBRT.



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Rovel J. Colaco

Therapeutic Radiology, Yale University

For correspondence:
rovelcolaco@doctors.org.uk

Henry S. Park

Therapeutic Radiology, Yale University

Maxwell S. Laurans

Neurosurgery, Yale University

Veronica S. Chiang

Neurosurgery, Yale University

James B. Yu

Radiation Oncology, Yale University

Zain A. Husain

Therapeutic Radiology, Yale University

Rovel J. Colaco

Therapeutic Radiology, Yale University

For correspondence:
rovelcolaco@doctors.org.uk

Henry S. Park

Therapeutic Radiology, Yale University

Maxwell S. Laurans

Neurosurgery, Yale University

Veronica S. Chiang

Neurosurgery, Yale University

James B. Yu

Radiation Oncology, Yale University

Zain A. Husain

Therapeutic Radiology, Yale University