Dose-escalated IGRT and spinal metastasis

The precision with which external beam radiation can be delivered to specific areas of the spine is recognized as being critical to the effectiveness and safety of this treatment for spinal cancer metastases, which are a common problem with progressive prostate cancer.

While not specific to prostate cancer, a new article by Guckenberger et al. reports on the use of dose-escalated, image-guided radiation therapy (IGRT) to treat 14 patients, 12 of whom had spinal metastases and a long life expectancy. A wide range of radiation doses was used (from 55 to 86 Gy) in a similarly wide range of dosing fractions (between 3 and 34) depending on the tumor volume and the precise clinical situation.

The patients were followed for a median of 17 months, and only one local recurrence was observed during that time period. The authors report that local control of the tumors was associated with rapid and long-term pain relief. However, of 11 patients treated for a solitary spinal metastasis, 6 went on to develop systemic disease progression. The actuarial overall survival rate for metastatic patients was 85 percent after a year and 63 percent after 2 years. Acute Grade 2-3 skin toxicity was seen in 2 patients but there was no evidence of late toxicity greater than Grade 2, nor was any radiation-induced myelopathy observed.

The authors conclude that dose-escalated irradiation of spinal metastases is safe and can result in excellent local control. They suggest that patients with a long life expectancy, a limited number of well-defined spinal metastases, and epidural involvement are likely to benefit the most from this type of fractionated radiation therapy.

One Response

  1. I can vouch for how effective targeted radiation on a spinal tumor can be. I had a tumor develop in my lower back over the summer of 2008. It was very painful (probably a 7 on a 1 to 10 scale); only taking many pain pills made it bearable. Then in October I did nine radiation treatments and within 2 weeks the pain and tumor were gone. It cost over $22,000 to get those nine treatments, but a year later I am still employed full-time and am pain free.

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