Vertebral metastases reirradiation with volumetric-modulated arc radiotherapy

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• 作者：Pierina Navarria^a ; ^{piera.navarria@humanitas.it} ; Pietro Mancosu^a ; Filippo Alongi^a ; Sara Pentimalli^a ; Angelo Tozzi^a ; Giacomo Reggiori^a ; Anna Maria Ascolese^a ; Stefano Arcangeli^a ; Francesca Lobefalo^a ; Riccardo Rodriguez Y. Baena^b ; Simona Castiglioni^a ; Federico Pessina^b ; Flavio Tancioni^b ; Armando Santoro^c ; Antonella Fogliata^d ; Luca Cozzi^d ; Marta Scorsetti^a
• 关键词：Spinal metastases ; Re-irradiation ; Volumetric-modulated-arc-therapy
• 刊名：Radiotherapy and Oncology
• 出版年：2012
• 期刊代码：231_01678140
• 类别：med
• 出版时间：March, 2012
• 卷：102
• 期：3
• 页码：416-420
• 文件大小：537 K

摘要

Purpose

To assess the feasibility, acute toxicity, clinical improvement, local control and survival for spinal metastatic patients re-irradiated using volumetric-modulated-arc-radiotherapy (VMAT).

Methods and materials

Between February 2009 and November 2010, 31 patients were treated. Surgery was performed in six before re-irradiation. The clinical target volume (CTV) was defined as the whole vertebrae with recurrence excluding the central section of spinal canal. Planning target volume was defined as CTV + 0-5 mm in the three directions. Dose was prescribed in order to have biological equivalent dose to the spinal cord from the two courses lower than 120 Gy₂ to 1 cc of the volume. Clinical improvement, toxicity and recurrence were evaluated. All patients had back pain before treatment and 15 (48%) neurological deficit.

Results

Clinical remission of pain was obtained in 29 patients (93%). Neurological improvement was observed in 73%of patients. No acute or late toxicities were recorded. No recurrence occurred. Median survival was 10 months (range 6-24). At the last follow-up 19 patients (61%) were alive and 12 (39%) dead from systemic disease progression. The 1 and 2 year survival were 55%and 35%, respectively.

Conclusion

In patients with spinal metastases recurrence re-irradiation with VMAT is feasible and provides clinical benefit in most patients.