Review Article

Stereotactic Body Radiosurgery for Spinal Metastatic Disease: An Evidence-Based Review

Table 1

Spine radiosurgical series through December 2010.

Authors and yearInstitutionNo. of pts/ tx sitesPrior RTTreatment systemDose/fraction No./coverageSpinal cord dose limitsHistologyMedian F/U (in months) Local control rate (percent)Pain improved (percent)Rate of myelopathy (percent)

Amdur et al., 2009 [39]U of Florida21/2512/21In house (Elekta Synergy-S)15 Gy/1/100% to 95% of PTV12 Gy to < 0 .1 cc, 5 Gy to <  0.5 cc if prior RTMany824/25 (96%)6/14 (43%)0/21 (0 %)
Gerszten et al., 2006 [40]U of Pittsburgh77/8770/77CyberKnife20 Gy (mean)/1/80% IDL9 Gy max (mean), range: 4–12 GyLung1687/87 (100%)65/73 (89%)0/77 (0%)
Gerszten et al., 2005 [41]U of Pittsburgh48/6042/48CyberKnife20 Gy (mean)/1/80% IDL9.7 Gy max (mean), range: 2.4–14.0 GyRenal3754/60 (90%)37/38 (97%)0/48 (0%)
Gerszten et al., 2005 [42]U of Pittsburgh28/3623/28CyberKnife21.7 Gy (mean)/1/80% IDL>8 Gy to 0.3 cc (range: 0–0.7 cc)Melanoma1326/28 (93%)27/28 (96%)0/28 (0%)
Gerszten et al., 2005 [43]U of Pittsburgh50/6848/50CyberKnife19 Gy (mean)/1/80% IDL13 Gy max doseBreast1668/68 (100%)55/57 (96%)0/50 (0%)
Gerszten et al., 2007 [44]U of Pittsburgh393/500344/500CyberKnife20 Gy (mean)/1/80% IDLNR>50% breast, lung, melanoma, renal21440/500 (88%)290/336 (86%)0/393 (0%)
Yamada et al., 2008 [45]Memorial Sloan-Kettering93/1030/93In house [46]24 Gy (median)/1/92% IDL (average)11.7 Gy max (median), range: 1.8–14 GyMany1590% (actuarial at 1 year)NR0/93 (0%)
Chang et al., 2007 [47]MD Anderson63/7435/63In house (Varian 21EX)tx 1 : 6 Gy/5/80–90% of PTVtx 2 : 9 Gy/3/80–90% of PTV10 Gy max in 5 fractions for tx 1 9 Gy max in 3 fractions for tx 2Many
(40% renal)
2184% (actuarial at 1 year)NR0/63 (0%)
Ryu et al., 2007 [32]Henry Ford Hospital177/2300/177Brainlab Novalis system8–18 Gy/1/90% IDL9.2 Gy (mean) to <10% of cord volumeMany
(25% breast)
6NRNR, 41/49 (84%) separate report [48]1/177 (0.5%)
Nelson et al., 2009 [49]Duke U32/3322/32In house (Varian 21EX)18 Gy (median)/3 (median)/12 Gy to 1% of cord, BED for retreatmentMany
(31% renal)
729/33 (88%)30/32 (94%)0/33 (0%)
Gibbs et al., 2007 [50]Stanford U74/10250/74Cyberknife16–25 Gy/1–5/77% IDL (mean), 98% of PTVMax dose range 3–28 Gy in 1–5 fractions>50% breast, lung, melanoma, renal9NR52/62 (84%, includes other neuro sxs)3/74 (4%)
Choi et al., 2010 [51]Stanford U42/5142/42Cyberknife20 Gy (median)/2 (median)/77% IDL (median)19.3 Gy max (median) in 1–5 fractions>50% breast, lung738/51 (75%)15/23 (65%)1/41
Degen et al., 2005 [52]Georgetown U51/7238/72Cyberknife21 Gy (mean)/3.6 (mean)/71% IDL (mean)11 Gy max (mean) to <1% of cord volumeMany (19% breast)1269/72 (96%)37/38 (97.3%)0/51 (0%)
Gagnon et al., 2009 [53]Georgetown U200/274137/274Cyberknife21, 26.4 or 37.5 Gy/3, 3 or 5/75% IDLNRMany (18% breast)12NR55/152 (36%) became pain-free0/200 (0%)
Sahgal et al., 2009 [54]UCSF39/6025/39Cyberknife24 Gy/3/67% or 60% IDL (no RT or prev. RT)16.8 Gy or 12.8 Gy max (median) (no RT or prev RT)Many985% (actuarial at 1 year)NR0/39 (0%)

Abbreviations: pts, patients; tx, treatment; F/U, followup; RT, radiation therapy; Gy, Gray; cc, cubic centimeter; PTV, planning target volume; IDL, isodose line; NR, not reported; BED, biologically equivalent dose.