SPINE STEREOTACTIC RADIOSURGERY FOR PATIENTS WITH METASTATIC THYROID CANCER - Secondary analysis of Phase I/II trials.

SPINE STEREOTACTIC RADIOSURGERY FOR PATIENTS WITH METASTATIC THYROID CANCER - Secondary analysis of Phase I/II trials.

Thyroid. 2016 Jun 22;

Authors: Bernstein MB, Chang EL, Amini B, Pan H, Cabanillas M, Wang XA, Allen PK, Rhines LD, Tatsui C, Li J, Brown PD, Ghia AJ

Abstract
Background Metastatic deposits to the spine in thyroid cancer patients represent the most common site of bone involvement and can contribute to pain, neurologic deficits, and death. In this study, we sought to determine the efficacy and safety of spine stereotactic radiosurgery (SSRS) for thyroid cancer patients. Methods Thyroid cancer patients with spine metastases were selected and analyzed from a cohort of patients that were prospectively enrolled in two, single-institution Phase I/II studies. SSRS was delivered in single or multi-fraction schedules. Dose regimens ranged from 16-18 Gy in one fraction or 27-30 Gy in 3-5 fractions. Toxicity was graded according to the NCI-CTC toxicity scale. Local control was determined by serial post-treatment MRI scans showing no evidence of progressive disease. Patients were followed until date of death or date of last known visit for survival analyses. Local control and overall survival rates were carried out using Kaplan-Meier estimates. The log-rank test was used to assess the equality of the survivor function across groups. A p-value of 0.05 or less was considered to be statistically significant. Results A total of 27 spine lesions were treated in 23 patients over a six-year period. Median follow-up was 28.9 months (range 5-93 months). Local control was 88% at two years and 79% at three years. Patients requiring upfront surgical intervention and treated with adjuvant SSRS achieved sustained control rates of 86% at three years. Overall survival rates were 85% and 67% at one and two years, respectively. In patients classified with oligoprogression and controlled extra-spinal disease, overall survival was significantly higher than those with evidence of systemic progression, 81% versus 45% at two years (p=0.01). No patient experienced any grade 3-5 toxicity. Pain flare was reported in 30% of patients with only three patients (13%) requiring narcotics or short-course steroids. There was no evidence of vertebral body fracture in any patient that achieved local control in the treated area. Conclusions Spine stereotactic radiosurgery for thyroid metastases as a primary or adjuvant/salvage therapy is well-tolerated and yields high rates of local control.  .

PMID: 27334245 [PubMed - as supplied by publisher]

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