Palliative Care

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TU_29_3026 - Outcomes of Spine Stereotactic Radiosurgery for the Treatment of Spine Metastases from Renal Cell Carcinoma

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Outcomes of Spine Stereotactic Radiosurgery for the Treatment of Spine Metastases from Renal Cell Carcinoma
E. H. Balagamwala1, R. H. Zhuang2, C. A. Reddy1, M. Y. Lee3, L. Angelov4, J. H. Suh1, and S. T. Chao5; 1Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 2Cleveland Cinic, Cleveland, OH, 3Cleveland Clinic Lerner College of Medicine, Cleveland, OH, 4Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, 5Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH

Purpose/Objective(s): Spine stereotactic radiosurgery (sSRS) has emerged as an important treatment option for patients with spine metastases from renal cell carcinoma (RCC). As systemic treatments continue to improve, the role of sSRS continues to evolve and many centers are utilizing sSRS in the upfront setting for patients with good prognosis.

Materials/Methods: Patients undergoing sSRS for metastatic RCC were included. The primary outcomes were radiographic control, which was assessed every three months with spine MRIs and pain progression was assessed clinically. Secondary outcomes included pain relief and post-SRS toxicity. Cumulative incidence methods were used to determine radiographic and pain failure rates over time. Fine and Gray regression was used to assess for associations between demographic, disease-related, and dosimetric characteristics and outcomes. All-cause mortality was considered as a competing event.

Results: 113 patients (173 treatments) with RCC spine metastases underwent single fraction sSRS and were included in this study. Median age, KPS and follow-up were 60.5 years (range, 38.9 – 86.8), 80 (range, 40 – 100), 5.5 months (range, 1 – 74.7), respectively. At last follow-up, 20 patients (17.7%) were alive. Median overall survival was 11.7 months. Overall, 41 treatments (23.7%) developed radiographic failure and 63 treatments (36.4%) developed pain progression after sSRS. Cumulative incidence for radiographic failure and pain progression at 6/12 months was 13.1%/17.6% and 18.9%/27.6%, respectively. Of the treatments included, 137 had pain at the time of treatment and 66% achieved pain relief. Median time to pain relief was 1.1 months (range, 0.1 – 7.5). 19.5% of treatments resulted in the development of vertebral compression fracture. Pain flare developed after 27 treatments (15.7%) and was treated with a short course of steroids. On univariate analysis, neural foraminal involvement was associated with increased risk for developing radiographic failure (HR 2.03, p=0.03). No other clinical or treatment-related factors were associated with radiographic failure or pain progression.

Conclusion: Spine SRS provides excellent radiographic and pain control rates for patients with spine metastases from RCC. As systemic therapies lead to improved outcomes and survival, the role of sSRS continues to evolve and expand. For patients with good prognosis and long expected survival, sSRS offers more durable local control and pain control and may be considered in the upfront setting.

Author Disclosure: E.H. Balagamwala: Employee; Cleveland Clinic. R.H. Zhuang: None. C.A. Reddy: Stipend; Red Journal. M.Y. Lee: None. L. Angelov: None. J.H. Suh: Consultant; ACMUI. Board member; Korean American Society for Therapeutic Radiation. S.T. Chao: Honoraria; Varian Medical Systems, Zeiss, Abbvie. Consultant; Abbvie.

Ehsan Balagamwala, MD

Disclosure:
Employment
Cleveland Clinic: Resident Physician: Employee, Staff Physician: Employee

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