Journal of Radiotherapy

Review Article

Stereotactic Hypofractionated Irradiation for Metastatic, Inoperable, and Recurrent Malignancies: A Modern Necessity, rather than a Luxury

Table 1

Recent literature regarding the use of SABR for spinal metastases.
StudyRemarksConclusions
Amdur et al. [30]Prospective phase-II trial (). 15 Gy single fraction SABR. 43% pain relief rate, 95% LC rate. Most patients died of systemic disease progression.
Chang et al. [28]Phase I/II design ().1-year progression free incidence of 84%. Pattern of failure analysis revealed two-mechanisms—one of recurrence in bone adjacent to previously treated site and the other of recurrence in epidural space adjacent to the spinal cord.
Yamada et al. [27]Single fraction SABR with doses of 18–24 Gy ().90% LC at median follow-up of 15 months. In all cases death was due to systemic disease progression and never due to local failure.
Ryu et al. [31]Assessed ability of SABR to provide durable pain relief ().Overall pain control rate of 84% at 1 year. Median duration of pain relief was 13.3 months.
RTOG 0631 [32]Study design included phase-2 and phase-3 components. Phase 2 component demonstrated feasibility and safety of SABR in large multi-institutional trial. Phase-3 component intends to assess pain relief and quality of life.
Gerszten et al. [33]Large prospective trial (). 69% patients had prior RT. Mean SABR dose of 20 Gy.Long term pain control in 86%.
Noticeable neurological improvement in 85%.
Milker-Zabel et al. [34]Retrospective analysis of SABR (median dose of 39.6 Gy) used in 18 patients with prior history of conventional RT.SABR safe for reirradiation. Improves symptom control in comparison to supportive care.
Moulding et al. [35]Used SABR adjuvantly after decompressive surgery in 20 patients.Only 5% local failure at 1 year. No wound related complications.
Sohn and Chung [36]Critical review of 31 studies using SABR for spinal metastases.1 year LC rates consistently above 90%.
Additional benefits include the feasibility of use in previously irradiated patients, excellent spinal cord sparing and can also be used after decompressive surgery.
SABR: stereotactic ablative body radiotherapy; LC: local control.