Dose-intensified SBRT for vertebral oligometastases: results from a prospective clinical trial
Year: 2025
Type: article
Abstract: PURPOSE: To prospectively evaluate safety and efficacy of dose-intensified multifraction SBRT using a simultaneous-integrated boost concept for vertebral oligometastases. MATERIAL AND METHODS: Data from 128 patients with 143 vertebral oligometastases (≤5 distant metastases in total) treated with dose-intensified SBRT (48.5 Gy/10 [with epidural involvement] or 40 Gy/5 [without epidural involvement]) in the randomized and non-randomized arms of a phase 3 clinical trial conducted at 18 international centers between 2016 and 2023 were analyzed. RESULTS: The median age of all patients was 68 years; 77 patients (60.2%) had breast and prostate cancer. Of 143 vertebral metastases, 23 (16.1%) and 22 metastases (15.4%) had epidural and paraspinal tumor involvement, respectively. The median follow-up time was 24 months. At 2 years, cumulative incidence of local failure (4 failures) was 5.3%. There were 4 (2.8%) baseline and 8 (5.6%) de novo vertebral compression fractures (VCFs). Two-year OS was 82.2% (95% CI, 74.9-89.6%). There was no grade ≥ 4 adverse events (AE) and the crude rate of grade 3 AEs was 5.5%; no myelopathy or plexopathy was observed. On multivariate analysis, only non-breast or non-prostate cancer (HR, 7.91; 95%, CI 1.79-35.03; 2-sided P = 0.01) were found to be prognostic for adverse OS. No prognostic factors for VCF were identified. Epidural and paraspinal involvement were not found to be prognostic for treatment outcome. CONCLUSIONS: Dose-intensified SBRT for vertebral oligometastases is effective and safe, even in high-risk patients with epidural or paraspinal involvement.
Source: Radiotherapy and Oncology
Authors: Matthias Guckenberger, Lotte Wilke, Charlotte Billiet, Susanne Rogers, Ciro Franzese, Daniel Schnell, Mateusz Spałek, Daniel M. Aebersold, Hossein Hemmatazad, Thomas Zilli, Judit Boda-Heggemann, Brigitta G. Baumert, Jean-Jacques Stelmes, Franziska Nägler, Philipp Gut, Christian Weiß, Alessio Bruni, Frank Zimmermann, Robert Förster, Jörg Zimmer, Indira Madani
Institutions: University of Zurich, University Hospital Zurich, Iridium Kankernetwerk, Kantonsspital Aarau, Humanitas University, University of Freiburg, University Medical Center Freiburg, The Maria Sklodowska-Curie National Research Institute of Oncology, University of Bern, University Hospital of Bern, University Hospital of Geneva, Heidelberg University, Medizinische Fakultät Mannheim, Kantonsspital Graubünden, Ente Ospedaliero Cantonale, Istituto Oncologico della Svizzera Italiana, University Hospital Leipzig, Klinik Hirslanden, Klinikum Darmstadt, Azienda Ospedaliero-Universitaria di Modena, University Hospital of Basel
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,770
Award: G7137598106
OpenAlex ID: W4410351502