• Assaf Moore, Zhigang Zhang, Teng Fei, Lei Zhang, Laura Accomando, Adam M Schmitt, Daniel S Higginson, Boris A Mueller, Melissa Zinovoy, Daphna Y Gelblum, Divya Yerramilli, Amy J Xu, Victoria S Brennan, David M Guttmann, Craig E Grossman, Laura L Dover, Narek Shaverdian, Luke R G Pike, John J Cuaron, Alexandra Dreyfuss, Eric Lis, Ori Barzilai, Mark H Bilsky, and Yoshiya Yamada.
• Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York , New York , USA.
• Neurosurgery. 2024 Aug 1; 95 (2): 380391380-391.

Background And PurposeA retrospective single-center analysis of the safety and efficacy of reirradiation to 40 Gy in 5 fractions (reSBRT) in patients previously treated with stereotactic body radiotherapy to the spine was performed.MethodsWe identified 102 consecutive patients treated with reSBRT for 105 lesions between 3/2013 and 8/2021. Sixty-three patients (61.8%) were treated to the same vertebral level, and 39 (38.2%) to overlapping immediately adjacent levels. Local control was defined as the absence of progression within the treated target volume. The probability of local progression was estimated using a cumulative incidence curve. Death without local progression was considered a competing risk.ResultsMost patients had extensive metastatic disease (54.9%) and were treated to the thoracic spine (53.8%). The most common regimen in the first course of stereotactic body radiotherapy was 27 Gy in 3 fractions, and the median time to reSBRT was 16.4 months. At the time of simulation, 44% of lesions had advanced epidural disease. Accordingly, 80% had myelogram simulations. Both the vertebral body and posterior elements were treated in 86% of lesions. At a median follow-up time of 13.2 months, local failure occurred in 10 lesions (9.5%). The 6- and 12-month cumulative incidences of local failure were 4.8% and 6%, respectively. Seven patients developed radiation-related neuropathy, and 1 patient developed myelopathy. The vertebral compression fracture rate was 16.7%.ConclusionIn patients with extensive disease involvement, reSBRT of spine metastases with 40 Gy in 5 fractions seems to be safe and effective. Prospective trials are needed to determine the optimal dose and fractionation in this clinical scenario.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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