TY - JOUR
T1 - An international pooled analysis of SBRT outcomes to oligometastatic spine and non-spine bone metastases
T2 - SBRT to bone oligometastases
AU - Cao, Yilin
AU - Chen, Hanbo
AU - Sahgal, Arjun
AU - Erler, Darby
AU - Badellino, Serena
AU - Biswas, Tithi
AU - Dagan, Roi
AU - Foote, Matthew C.
AU - Louie, Alexander V.
AU - Poon, Ian
AU - Ricardi, Umberto
AU - Redmond, Kristin J.
N1 - Funding Information:
Drs Cao and Chen have no disclosures. All other authors reported receiving travel support from Elekta AB through the Consortium for Oligometastases Research (CORE). Dr Sahgal reported conducting educational seminars for Medtronic, Elekta AB, Accuray, and Varian Medical Systems; receiving research grants from Elekta AB; and being part of the Elekta MR-Linac Consortium. Dr Biswas reported advisory board positions with Galera Therapeutics and AstraZeneca. Dr Dagan reported receiving research grants from Elekta AB. Dr Foote reported receiving research support from Elekta AB. Dr Louie reported receiving honoraria from Varian Medical Systems, AstraZeneca, and RefleXion. Dr Poon reports research grants from Elekta AB and advisory board positions with Sanofi Aventis and AstraZeneca. Dr Redmond reported receiving research support, travel expenses, and honoraria for educational seminars from Accuray; participating on a data and safety monitoring board for BioMimetix; and receiving travel expenses from Brainlab.
Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/11
Y1 - 2021/11
N2 - Purpose: There is a paucity of data on SBRT to non-spine bone (NSB) lesions compared to spine metastases. We report local recurrence (LR), widespread progression (WSP), and overall survival (OS) for oligometastatic patients treated to bone lesions with SBRT and investigate the hypothesis that outcomes are different between patients with spine and non-spine bone oligometastatic disease. Methods: Patients with oligometastatic disease (≤5 cumulative extracranial metastases) treated with bone SBRT at 6 international institutions from 2007 to 2016 were reviewed. Fine and Gray competing risks and Cox regressions were used to analyze univariable and multivariable relationships between disease/treatment factors and outcomes. Results: In total, 288 spine and 233 NSB lesions are reported in 356 patients. Cumulative incidence of LR across all bone lesions was 6.3%, 12.6% and 19.3% at 6 mo, 1 yr and 2 yrs. While univariable analysis suggested inferior LC and OS in spine patients, this did not hold true in multivariable analysis. The final regression model for LR in NSB lesions included PTV ≥ median of 31.8 cc (HR 5.02, p = 0.014) and primary histology, with RCC and NSCLC conferring a 10.8- and 6.5-fold increased risk of LR compared to prostate histology, respectively. The spine LR model included radioresistant histology (HR 2.11, p = 0.0051), PTV Dmin (BED10) ≥ median of 19.1 Gy (HR 0.46, p = 0.0085), and epidural disease (HR 1.99, p = 0.016). Conclusion: This large multi-institutional series reports comparably excellent response to SBRT for a balanced distribution of oligometastatic NSB and spine lesions. Dose escalation for large and/or radioresistant NSB lesions should be explored, given the typical lack of an immediately adjacent dose-limiting critical structure.
AB - Purpose: There is a paucity of data on SBRT to non-spine bone (NSB) lesions compared to spine metastases. We report local recurrence (LR), widespread progression (WSP), and overall survival (OS) for oligometastatic patients treated to bone lesions with SBRT and investigate the hypothesis that outcomes are different between patients with spine and non-spine bone oligometastatic disease. Methods: Patients with oligometastatic disease (≤5 cumulative extracranial metastases) treated with bone SBRT at 6 international institutions from 2007 to 2016 were reviewed. Fine and Gray competing risks and Cox regressions were used to analyze univariable and multivariable relationships between disease/treatment factors and outcomes. Results: In total, 288 spine and 233 NSB lesions are reported in 356 patients. Cumulative incidence of LR across all bone lesions was 6.3%, 12.6% and 19.3% at 6 mo, 1 yr and 2 yrs. While univariable analysis suggested inferior LC and OS in spine patients, this did not hold true in multivariable analysis. The final regression model for LR in NSB lesions included PTV ≥ median of 31.8 cc (HR 5.02, p = 0.014) and primary histology, with RCC and NSCLC conferring a 10.8- and 6.5-fold increased risk of LR compared to prostate histology, respectively. The spine LR model included radioresistant histology (HR 2.11, p = 0.0051), PTV Dmin (BED10) ≥ median of 19.1 Gy (HR 0.46, p = 0.0085), and epidural disease (HR 1.99, p = 0.016). Conclusion: This large multi-institutional series reports comparably excellent response to SBRT for a balanced distribution of oligometastatic NSB and spine lesions. Dose escalation for large and/or radioresistant NSB lesions should be explored, given the typical lack of an immediately adjacent dose-limiting critical structure.
KW - Bone metastases
KW - Non-spine bone
KW - Oligometastatic
KW - SBRT
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U2 - 10.1016/j.radonc.2021.08.011
DO - 10.1016/j.radonc.2021.08.011
M3 - Article
C2 - 34454974
AN - SCOPUS:85116332497
SN - 0167-8140
VL - 164
SP - 98
EP - 103
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -