RESUMO
PURPOSE: Single-fraction radiation surgery for spine metastases is highly effective. However, a high rate (20-39%) of vertebral body fracture (VBF) has been associated with large, single-fraction doses. We report our experience using multifraction stereotactic body radiation therapy (SBRT). METHODS AND MATERIALS: All patients who were treated with multifraction SBRT for spine metastases at our institution between 2009 and 2017 were retrospectively analyzed. SBRT was delivered in 2 to 5 fractions using the Cyberknife System (Accuray, Sunnyvale, CA). Patients were followed clinically and with magnetic resonance imaging every 3 to 6 months. Local control, complications (including VBF), and overall survival were evaluated. Patient, disease, and treatment variables were analyzed for a statistical association with outcomes. RESULTS: A total of 83 patients were treated to 98 spine lesions with a median follow-up of 7.6 months. Histologies included non-small cell lung cancer (NSCLC; 24%), renal cell carcinoma (RCC; 18%), and breast cancer (12%). Surgery or vertebroplasty were performed before SBRT in 21% of cases. Patients received a median SBRT dose of 24 Gy in a median of 3 fractions. Local control was 93% at 6 months and 84% at 1 year. Higher prescribed dose, higher biologic effective dose, higher minimum dose to 90% of the planning target volume, tumor histology, and smaller tumor volume predicted improved local control. The cumulative dose was 23 Gy versus 26 Gy for patients with and without failure (P = .02), higher biologic effective dose 39 Gy versus 46 Gy, (P = .01), and higher minimum dose to 90% of the planning target volume 23 Gy versus 26 Gy (P = .03). VBF occurred in 4.2% of all cases and 5.3% of those without surgery or vertebroplasty prior to SBRT. Only preexisting VBF predicted risk of post-SBRT VBF (P < .01). CONCLUSIONS: Multifraction SBRT results in a high local control rate for metastatic spinal disease with a low VBF rate, which suggests a favorable therapeutic ratio compared with single-fraction SBRT.
RESUMO
BACKGROUND: Brain metastases (BM) occur in â¼5% of breast cancer patients. BRCA1-associated cancers are often basal-like and basal-like cancers are known to have a predilection for central nervous system metastases. We performed a matched-pair analysis of breast cancer patients with and without BRCA mutations and compared the frequency of BM in both groups. MATERIALS AND METHODS: From a database of 1935 patients treated for localized breast cancer at our institution from 2009 to 2014 we identified 20 patients with BRCA1 or BRCA2 mutations and manually matched 40 patients without BRCA mutations accounting for age, stage, estrogen receptor expression, and human epidermal growth factor receptor 2 (HER2) expression. Comparisons of freedom from brain metastasis, brain metastasis-free survival, and overall survival were made using the log rank test. Testing for a basal-type phenotype using the immunohistochemistry definition (ER/PR/HER2 and either CK 5/6 or EGFR) was performed for BRCA patients who developed BM and their matched controls. RESULTS: We analyzed 60 patients: 20 BRCA and 40 were matched controls. Median follow-up was 37 and 49 months, respectively. Three years freedom from brain metastasis was 84% for BRCA patients and 97% for BRCA controls (P=0.049). Three years brain metastasis-free survival was 84% and 97% for the BRCA+ and controls, respectively (P=0.176). Mean time to brain failure was 11 months from diagnosis for the BRCA patients. All 3 BRCA1 patients who developed BM were of a basal-type triple negative phenotype. CONCLUSIONS: Breast cancer patients with germline BRCA1 mutations appear to have a shorter interval to brain progression while accounting for confounding factors.
Assuntos
Proteína BRCA1/genética , Proteína BRCA2/genética , Biomarcadores Tumorais/genética , Neoplasias Encefálicas/secundário , Neoplasias da Mama/patologia , Mutação , Adulto , Idoso , Neoplasias Encefálicas/genética , Neoplasias da Mama/genética , Feminino , Seguimentos , Humanos , Análise por Pareamento , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de SobrevidaRESUMO
PURPOSE: We examined the radiotherapy patterns of care over an 8-year period during which the PORTEC-2 trial and other series were published. METHODS AND MATERIALS: Patients diagnosed with Stage I endometrioid adenocarcinoma (EA) between 2004 and 2011 were identified in the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Adjuvant radiation treatments were analyzed by year. Patterns of care from 2004 to 2008 were compared to those from 2009 to 2011 using the χ2 test. RESULTS: Analysis included 31,688 patients with Stage I EA. Among those diagnosed in 2004, 9.3% received adjuvant external beam radiotherapy (EBRT) and 5.0% received adjuvant brachytherapy. In 2011, 4.5% received EBRT and 9.3% received brachytherapy. In those diagnosed with high-intermediate risk (H-IR) EA in 2004, 58.8% received no adjuvant treatment, 28.3% received EBRT, and 12.9% received brachytherapy. In 2011, 57.8% of patients with H-IR disease received no adjuvant treatment, 14.3% received EBRT, and 27.9% received brachytherapy. There was a significant difference in the proportion of patients with H-IR EA treated with EBRT vs. brachytherapy alone before and after 2008 (p < 0.0001) with an increase in use of brachytherapy and a decrease in the use of EBRT. CONCLUSIONS: The use of brachytherapy alone after hysterectomy has increased over time in all women with Stage I EA and in those with H-IR disease. In almost all subsets, the proportion of women being treated with brachytherapy increased and the proportion treated with EBRT decreased. Less than 30% received adjuvant brachytherapy and over 50% of women were treated without adjuvant radiotherapy.