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Purpose <p>Although stereotactic body radiotherapy (SBRT) has radically transformed the treatment paradigm for spinal metastases, long-term outcomes of upfront SBRT in patients with spinal metastases remain underreported.</p> Methods <p>A cohort of 100 patients (131 treatments) with spinal metastases treated with upfront SBRT alone from 2001 to 2024 was analyzed. Patients with prior lesion-specific surgery or radiotherapy, or less than 6 months of follow-up, were excluded. The median single- and multi-fraction prescription doses were 16-Gy (IQR: 16–18) and 24-Gy (IQR: 24–27), respectively.</p> Results <p>The median follow-up was 21 months (IQR: 12–57). The 1- and 2-year local tumor control (LTC) rates were 86% (95%CI: 80-92%) and 81% (95%CI: 73-88%), respectively. On multivariable analysis, tumor volume &gt; 23&#xa0;cc (HR: 3.20, 95%CI: 1.02–10.1, <i>p</i> = 0.047) was significantly associated with worsened LTC. Patient-reported pain improved or remained stable in 89% and 87% of cases at 6- months and 12-months following SBRT. The median overall survival (OS) was 33 months (IQR: 13–57), with polymetastatic disease (HR: 1.80, 95%CI: 1.05–3.09, <i>p</i> = 0.032) being significantly associated with worsened OS. There were 19 (15%) vertebral compression fractures (VCFs) that developed following SBRT. On multivariable analysis, lumbar lesions (HR: 2.61, 95%CI: 1.01–6.76, <i>p</i> = 0.048) and baseline VCFs (HR: 2.80, 95%CI: 1.10–7.09, <i>p</i> = 0.030) were predictive of VCF development following SBRT.</p> Conclusions <p>Upfront SBRT alone provides durable long-term local tumor control and sustained pain relief, with minimal toxicity. These findings support the integration of SBRT as a definitive, minimally invasive treatment option for appropriately selected patients, which may obviate the need for future open surgical intervention.</p>

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Long term outcomes following upfront stereotactic body radiotherapy alone for spinal metastases

  • 期刊论文

  • 发表日期：

    2025年6月16日

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  • Suchet Taori,
  • Samuel Adida,
  • James C. Bayley,
  • Pascal O. Zinn,
  • Steven A. Burton,
  • John C. Flickinger,
  • Roberta K. Sefcik,
  • Peter C. Gerszten

摘要

Purpose

Although stereotactic body radiotherapy (SBRT) has radically transformed the treatment paradigm for spinal metastases, long-term outcomes of upfront SBRT in patients with spinal metastases remain underreported.

Methods

A cohort of 100 patients (131 treatments) with spinal metastases treated with upfront SBRT alone from 2001 to 2024 was analyzed. Patients with prior lesion-specific surgery or radiotherapy, or less than 6 months of follow-up, were excluded. The median single- and multi-fraction prescription doses were 16-Gy (IQR: 16–18) and 24-Gy (IQR: 24–27), respectively.

Results

The median follow-up was 21 months (IQR: 12–57). The 1- and 2-year local tumor control (LTC) rates were 86% (95%CI: 80-92%) and 81% (95%CI: 73-88%), respectively. On multivariable analysis, tumor volume > 23 cc (HR: 3.20, 95%CI: 1.02–10.1, p = 0.047) was significantly associated with worsened LTC. Patient-reported pain improved or remained stable in 89% and 87% of cases at 6- months and 12-months following SBRT. The median overall survival (OS) was 33 months (IQR: 13–57), with polymetastatic disease (HR: 1.80, 95%CI: 1.05–3.09, p = 0.032) being significantly associated with worsened OS. There were 19 (15%) vertebral compression fractures (VCFs) that developed following SBRT. On multivariable analysis, lumbar lesions (HR: 2.61, 95%CI: 1.01–6.76, p = 0.048) and baseline VCFs (HR: 2.80, 95%CI: 1.10–7.09, p = 0.030) were predictive of VCF development following SBRT.

Conclusions

Upfront SBRT alone provides durable long-term local tumor control and sustained pain relief, with minimal toxicity. These findings support the integration of SBRT as a definitive, minimally invasive treatment option for appropriately selected patients, which may obviate the need for future open surgical intervention.