Efficacy and safety of different fractions in stereotactic body radiotherapy for spinal metastases: A systematic review

Yining Gong; Lingyi Xu; Hongqing Zhuang; Liang Jiang; Feng Wei; Zhongjun Liu; Yan Li; Miao Yu; Kaiwen Ni; Xiaoguang Liu

doi:10.1002/cam4.2546

Efficacy and safety of different fractions in stereotactic body radiotherapy for spinal metastases: A systematic review

Cancer Med. 2019 Oct;8(14):6176-6184. doi: 10.1002/cam4.2546. Epub 2019 Sep 5.

Authors

Yining Gong¹, Lingyi Xu², Hongqing Zhuang³, Liang Jiang¹, Feng Wei¹, Zhongjun Liu¹, Yan Li¹, Miao Yu¹, Kaiwen Ni⁴, Xiaoguang Liu¹

Affiliations

¹ Department of Orthopedics, Peking University Third Hospital, Beijing, China.
² Eight-Year-Program, Grade 2015, Health Science Center, Peking University, Beijing, China.
³ Department of Radiation Oncology, Peking University Third Hospital, Beijing, China.
⁴ Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.

Abstract

Background: In the treatment of spinal metastases, stereotactic body radiotherapy (SBRT) delivers precise, high-dose radiation to the target region while sparing the spinal cord. A range of doses and fractions had been reported; however, the optimal prescribed scheme remains unclear.

Methods: Two reviewers performed independent literature searches of the PubMed, EMBASE, Cochrane Database, and Web of Science databases. Articles were divided into one to five fractions groups. The Methodological Index for Non-randomized Studies (MINORS) was used to assess the quality of studies. Local control (LC) and overall survival (OS) were presented for the included studies and a pooled value was calculated by the weighted average.

Results: The 38 included studies comprised 3,754 patients with 4,731 lesions. The average 1-year LCs for the one to five fractions were 92.7%, 84.6%, 86.8%, 82.6%, and 80.6%, respectively. The average 1-year OS for the one to five fractions were 53.0%, 70.4%, 60.1%, 48%, and 80%, respectively. The 24 Gy/single fraction scheme had a higher 1-year LC (98.1%) than those of 24 Gy/two fractions (85.4%), 27 Gy/three fractions (84.9%), and 24 Gy/three fractions (89.0%). The incidence of vertebral compression fracture was 10.3%, with 10.7% in the single-fraction group and 10.1% in the multi-fraction group. The incidence of radiation-induced myelopathy was 0.19%; three and two patients were treated with single-fraction and multi-fraction SBRT, respectively. The incidence of radiculopathy was 0.30% and all but one patient were treated with multi-fraction SBRT.

Conclusions: SBRT provided satisfactory efficacy and acceptable safety for spinal metastases. Single-fraction SBRT demonstrated a higher local control rate than those of the other factions, especially the 24 Gy dose. The risk of vertebral compression fracture (VCF) was slightly higher in single-fraction SBRT and more patients developed radiculopathy after multi-fraction SBRT.

Keywords: multi-fraction; single-fraction; spinal metastases; stereotactic body radiotherapy; stereotactic radiosurgery; systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Dose Fractionation, Radiation*
Female
Fractures, Compression / diagnosis
Fractures, Compression / etiology
Humans
Male
Prognosis
Radiculopathy / etiology
Radiosurgery / adverse effects
Radiosurgery / methods*
Spinal Cord Diseases / etiology
Spinal Neoplasms / complications
Spinal Neoplasms / mortality
Spinal Neoplasms / radiotherapy*
Spinal Neoplasms / secondary*
Treatment Outcome