Vienna, Austria

ESTRO 2023

Session Item

May 14
10:30 - 11:30
Hall A
Haematology - CNS
Giuseppe Minniti, Italy;
Lena Specht, Denmark
Proffered Papers
11:00 - 11:10
Long-term results from a phase 1 trial of spine SBRT in inoperable patients with cord compression
Amol Ghia, USA


Long-term results from a phase 1 trial of spine SBRT in inoperable patients with cord compression

Amol Ghia1, Nandita Guha-Thakurta2, Jing Li1, Stephen Settle3, MaryFrances McAleer1, Tina Briere4, Claudio Tatsui5, Paul Brown6, Thomas Beckham1, Chenyang Wang1, Debra Yeboa1, Eric Chang7, Laurence Rhines5

1University of Texas, MD Anderson Cancer Center, Radiation Oncology, Houston, USA; 2University of Texas, MD Anderson Cancer Center, Diagnostic Radiology, Houston, USA; 3Alaska Cyberknife Center, Radiation Oncology, Anchorage, USA; 4University of Texas, MD Anderson Cancer Center, Radiation Physics, Houston, USA; 5University of Texas, MD Anderson Cancer Center, Neurosurgery, Houston, USA; 6Mayo Clinic, Radiation Oncology, Rochester, USA; 7University of Southern California, Keck School of Medicine, Radiation Oncology, Los Angeles, USA

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Purpose or Objective

We seek to establish the feasibility of using spine stereotactic radiosurgery (SSRS) allowing for spinal cord dose constraint relaxation as the primary management of metastatic epidural spinal cord compression (MESCC) in inoperable patients monitoring for radiation related toxicity and radiographic local control (LC).

Material and Methods

Patients with MESCC in the thoracic spine deemed inoperable with no prior history of radiation at the site of interest were enrolled on this prospective Phase 1 single institution protocol (Figure 1).  Single fraction SSRS was delivered to a histology dependent prescription dose of 18 or 24 Gy.  Spinal cord constraint relaxation was performed from an initial allowable Dmax cohort of 10 Gy only if tumor progression occurred.  If the risk of radiation induced spinal cord myelopathy (RM) remained lower than the risk of tumor progression, then the cord Dmax was elevated in 2 Gy increments to a maximum of 16 Gy in the final cohort.  Patients were monitored every 3 months with follow-up visits, MRI scans and validated patient reported outcome surveys.


Thirty two patients enrolled on the trial of which 4, 12, 8 and 8 were in the 10 Gy, 12 Gy, 14 Gy and 16 Gy  cord Dmax cohorts, respectively.  The most common histology was renal cell carcinoma (n=12).  The most common GTV prescription dose was 18 Gy (n=17) followed by 24 Gy (n=15).  The median age was 62.7 yrs (range 35-81 yrs).  At baseline, there were 10 sites with MESCC Grade 1B, 10 sites with Grade 1C, 9 sites with Grade 2, 2 sites with Grade 1A, and 1 site with Grade 3 disease.

Of the 32 patients treated with SSRS, 4 were lost to follow-up without post-SSRS evaluation.  Of the remaining 28 patients, the median overall survival was 32.3 months (range 5.8-122.6 mo).  The 1-year and 5-year LC was 84.5% and 79.5%, respectively, while the median LC was not met  The 2-year LC did not statistically differ between the 14-16 Gy cord Dmax combined cohorts and the 10-12 Gy cord Dmax combined cohorts (92.9% vs. 62.9%, p=0.15)(Figure 2).  With a median clinical follow-up of 22.7 months (range 3-122.3 mo), there were no cases of RM including in the 13 patients who survived at least 3 years.  In the cohort receiving a cord Dmax of 16 Gy, there were no cases of RM with a median follow-up of 18.6 mo (range 9.0-97.1 mo).


With long-term follow-up, these data demonstrate that SSRS is a safe and effective tool in patients with MESCC.  Cord constraint relaxation may be considered in inoperable patients with MESCC.