Clinical outcomes after reirradiation of paraspinal tumors

Jean Wright, D. Michael Lovelock, Mark H. Bilsky, Sean Toner, Joan Zatcky, Yoshiya Yamada

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: We present our experience with reirradiation of locally recurrent paraspinal tumors using image-guided intensity modulated radiotherapy (IG-IMRT). METHODS: We performed a retrospective review of 37 patients who were reirradiated using IG-IMRT for recurrent paraspinal tumors between 2000 and 2005. We evaluated radiation dose to the spinal cord or cauda equina in first and second radiation treatments, time to first recurrence, and clinical outcomes after reirradiation including second recurrence, survival, pain, functional status, and toxicity. RESULTS: Median time to local failure after first radiation was 13 months. All patients underwent salvage reirradiation, postoperatively or with IG-IMRT alone. Median radiation dose to the planning target volume (PTV) was 2000 cGy; median spinal cord or cauda equina dose was 990 cGy. Median cumulative spinal cord or cauda equina dose was 4198 cGy. Local control probability at a median follow-up of 8 months was 60%; median interval to second failure was 13 months. Survival probability at a median follow up of 12 months was 72%; median survival was 18 months. Thirty-four patients (91%) reported stable or improved pain after second radiation, and 26 (70%) had a stable or improved functional status. Mild acute toxicity occurred in 3 patients (8%). No long-term toxicity has been identified. CONCLUSIONS: Reirradiation using IG-IMRT is safe and achieves a meaningful interval of local control with improved symptoms. Further studies with more patients and longer follow up are needed to evaluate toxicity, predictors of failure, and timing of radiation after surgical salvage.

Original languageEnglish (US)
Pages (from-to)495-502
Number of pages8
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume29
Issue number5
DOIs
StatePublished - Oct 2006
Externally publishedYes

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Image-Guided Radiotherapy
Intensity-Modulated Radiotherapy
Radiation
Cauda Equina
Neoplasms
Spinal Cord
Survival
Recurrence
Pain
Re-Irradiation

Keywords

  • Image-guided
  • IMRT
  • Paraspinal
  • Reirradiation

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Clinical outcomes after reirradiation of paraspinal tumors. / Wright, Jean; Lovelock, D. Michael; Bilsky, Mark H.; Toner, Sean; Zatcky, Joan; Yamada, Yoshiya.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 29, No. 5, 10.2006, p. 495-502.

Research output: Contribution to journalArticle

Wright, Jean ; Lovelock, D. Michael ; Bilsky, Mark H. ; Toner, Sean ; Zatcky, Joan ; Yamada, Yoshiya. / Clinical outcomes after reirradiation of paraspinal tumors. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2006 ; Vol. 29, No. 5. pp. 495-502.
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N2 - OBJECTIVE: We present our experience with reirradiation of locally recurrent paraspinal tumors using image-guided intensity modulated radiotherapy (IG-IMRT). METHODS: We performed a retrospective review of 37 patients who were reirradiated using IG-IMRT for recurrent paraspinal tumors between 2000 and 2005. We evaluated radiation dose to the spinal cord or cauda equina in first and second radiation treatments, time to first recurrence, and clinical outcomes after reirradiation including second recurrence, survival, pain, functional status, and toxicity. RESULTS: Median time to local failure after first radiation was 13 months. All patients underwent salvage reirradiation, postoperatively or with IG-IMRT alone. Median radiation dose to the planning target volume (PTV) was 2000 cGy; median spinal cord or cauda equina dose was 990 cGy. Median cumulative spinal cord or cauda equina dose was 4198 cGy. Local control probability at a median follow-up of 8 months was 60%; median interval to second failure was 13 months. Survival probability at a median follow up of 12 months was 72%; median survival was 18 months. Thirty-four patients (91%) reported stable or improved pain after second radiation, and 26 (70%) had a stable or improved functional status. Mild acute toxicity occurred in 3 patients (8%). No long-term toxicity has been identified. CONCLUSIONS: Reirradiation using IG-IMRT is safe and achieves a meaningful interval of local control with improved symptoms. Further studies with more patients and longer follow up are needed to evaluate toxicity, predictors of failure, and timing of radiation after surgical salvage.

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