{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:47:21Z","timestamp":1792194441797,"version":"4.4.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T00:00:00Z","timestamp":1588723200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Upon progression after upfront radiotherapy to spinal metastases, low-dose re-irradiation conventional external beam radiation (cEBRT) provides limited clinical benefit. Spine stereotactic body radiotherapy (SBRT) allows for dose escalation in the salvage setting with the potential for improved local control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To report mature clinical and imaging-based outcomes for salvage SBRT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective review was undertaken of consecutive patients with spinal metastases treated with re-irradiation spine SBRT having failed either cEBRT (n\u00a0=\u00a060 with 1 prior course and n\u00a0=\u00a017 with 2 or more prior cEBRT courses), or prior SBRT (n\u00a0=\u00a06) to the same spinal segment. The primary outcome was local failure (LF), and secondary outcomes included overall survival (OS) and the rate of vertebral compression fracture (VCF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 43 patients with 83 spinal segments treated with salvage SBRT were reviewed. The crude risk of LF was 18%, and actuarial LF rates at 6, 12, and 24 mo were 7%, 14%, and 19%, respectively. The presence of extensive paraspinal disease (hazard ratio [HR]\u00a0=\u00a07.1, 95% CI 1.5-34) significantly predicted for LF. The median OS was 13.2 (95% CI 6.1-16.3) mo, and the presence of neurological deficits (HR\u00a0=\u00a04.7, 95% CI 1.8-12.1) and brain metastases (HR\u00a0=\u00a02.6, 95% CI 1.1-6.3) were significant prognostic factors. The crude risk of VCF was 4%, and radiation myelopathy was not observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>These data support the safety and efficacy of spinal re-irradiation with SBRT including patients with prior SBRT and multiple courses of prior cEBRT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyaa109","type":"journal-article","created":{"date-parts":[[2020,3,9]],"date-time":"2020-03-09T16:22:47Z","timestamp":1583770967000},"page":"816-822","source":"Crossref","is-referenced-by-count":25,"title":["Mature Imaging-Based Outcomes Supporting Local Control for Complex Reirradiation Salvage Spine Stereotactic Body Radiotherapy"],"prefix":"10.1227","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0117-6839","authenticated-orcid":false,"given":"Jay S","family":"Detsky","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy K","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, London Health Sciences Centre, London, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshetu","family":"Atenafu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pejman","family":"Maralani","sequence":"additional","affiliation":[{"name":"Medical Imaging, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zain","family":"Husain","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Lin","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sten","family":"Myrehaug","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hany","family":"Soliman","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Sahgal","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,10]]},"reference":[{"issue":"1-3","key":"bib1-20231212","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000099658","article-title":"LINAC-based spinal stereotactic radiosurgery","volume":"66","author":"Hamilton","year":"1996","journal-title":"Stereotact Funct Neurosurg"},{"issue":"3","key":"bib2-20231212","doi-asserted-by":"crossref","first-page":"e555","DOI":"10.1016\/j.ijrobp.2011.06.1980","article-title":"Spine stereotactic body radiotherapy utilizing cone-beam CT image-guidance with a robotic couch: intrafraction motion analysis accounting for all six degrees of freedom","volume":"82","author":"Hyde","year":"2012","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"3","key":"bib3-20231212","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.jmir.2013.04.002","article-title":"Stereotactic body radiotherapy for the treatment of spinal metastases: an overview of the University of Toronto, Sunnybrook Health Sciences Odette Cancer Centre, technique","volume":"44","author":"Sangha","year":"2013","journal-title":"J Med Imaging Radiat Sci"},{"issue":"2","key":"bib4-20231212","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/S1470-2045(13)70556-4","article-title":"Single versus multiple fractions of repeat radiation for painful bone metastases: a randomised, controlled, non-inferiority trial","volume":"15","author":"Chow","year":"2014","journal-title":"Lancet Oncol"},{"issue":"5","key":"bib5-20231212","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1016\/j.ijrobp.2016.03.027","article-title":"Postoperative stereotactic body radiation therapy (SBRT) for spine metastases: a critical review to guide practice","volume":"95","author":"Redmond","year":"2016","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"2","key":"bib6-20231212","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.prro.2013.05.001","article-title":"RTOG 0631 phase 2\/3 study of image guided stereotactic radiosurgery for localized (1-3) spine metastases: phase 2 results","volume":"4","author":"Ryu","year":"2014","journal-title":"Pract Radiat Oncol"},{"issue":"18","key":"bib7-20231212","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1200\/JCO.19.00201","article-title":"Local consolidative therapy vs. maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer: long-term results of a multi-institutional, phase II, randomized study","volume":"37","author":"Gomez","year":"2019","journal-title":"J Clin Oncol"},{"issue":"10185","key":"bib8-20231212","doi-asserted-by":"crossref","first-page":"2051","DOI":"10.1016\/S0140-6736(18)32487-5","article-title":"Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial","volume":"393","author":"Palma","year":"2019","journal-title":"Lancet North Am Ed"},{"issue":"3","key":"bib10-20231212","doi-asserted-by":"crossref","first-page":"295","DOI":"10.3171\/2017.1.SPINE16684","article-title":"Stereotactic body radiotherapy for de novo spinal metastases: systematic review","volume":"27","author":"Husain","year":"2017","journal-title":"J Neurosurg Spine"},{"issue":"4","key":"bib11-20231212","doi-asserted-by":"crossref","first-page":"428","DOI":"10.3171\/2017.2.SPINE16976","article-title":"Reirradiation spine stereotactic body radiation therapy for spinal metastases: systematic review","volume":"27","author":"Myrehaug","year":"2017","journal-title":"J Neurosurg Spine"},{"issue":"15","key":"bib12-20231212","doi-asserted-by":"crossref","first-page":"3509","DOI":"10.1002\/cncr.25918","article-title":"Prospective evaluation of spinal reirradiation by using stereotactic body radiation therapy","volume":"117","author":"Garg","year":"2011","journal-title":"Cancer"},{"issue":"5","key":"bib13-20231212","doi-asserted-by":"crossref","first-page":"589","DOI":"10.3109\/0284186X.2012.666637","article-title":"Local tumor control after retreatment of spinal metastasis using stereotactic body radiotherapy; comparison with initial treatment group","volume":"51","author":"Chang","year":"2012","journal-title":"Acta Oncol (Madr)"},{"issue":"2","key":"bib14-20231212","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.ijrobp.2015.03.029","article-title":"Salvage stereotactic body radiotherapy (SBRT) following in-field failure of initial SBRT for spinal metastases","volume":"93","author":"Thibault","year":"2015","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"16","key":"bib15-20231212","doi-asserted-by":"crossref","first-page":"e595","DOI":"10.1016\/S1470-2045(15)00166-7","article-title":"Response assessment after stereotactic body radiotherapy for spinal metastasis: a report from the SPIne response assessment in neuro-oncology (SPINO) group","volume":"16","author":"Thibault","year":"2015","journal-title":"Lancet Oncol"},{"issue":"2","key":"bib16-20231212","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1177\/1533034616681674","article-title":"Positional accuracy of treating multiple versus single vertebral metastases with stereotactic body radiotherapy","volume":"16","author":"Chang","year":"2017","journal-title":"Technol Cancer Res Treat"},{"issue":"5","key":"bib17-20231212","doi-asserted-by":"crossref","first-page":"e597","DOI":"10.1016\/j.ijrobp.2012.03.009","article-title":"International spine radiosurgery consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery","volume":"83","author":"Cox","year":"2012","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"1","key":"bib18-20231212","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.ijrobp.2010.08.021","article-title":"Reirradiation human spinal cord tolerance for stereotactic body radiotherapy","volume":"82","author":"Sahgal","year":"2012","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"3","key":"bib19-20231212","doi-asserted-by":"crossref","first-page":"324","DOI":"10.3171\/2010.3.SPINE09459","article-title":"Reliability analysis of the epidural spinal cord compression scale","volume":"13","author":"Bilsky","year":"2010","journal-title":"J Neurosurg Spine"},{"issue":"1","key":"bib20-20231212","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/1748-717X-9-69","article-title":"Reliability of the spinal instability neoplastic score (SINS) among radiation oncologists: an assessment of instability secondary to spinal metastases","volume":"9","author":"Fisher","year":"2014","journal-title":"Radiat Oncol"},{"issue":"3","key":"bib21-20231212","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1093\/neuros\/nyx493","article-title":"Vertebral compression fracture after spine stereotactic body radiation therapy: a review of the pathophysiology and risk factors","volume":"83","author":"Faruqi","year":"2018","journal-title":"Neurosurgery"},{"issue":"8","key":"bib22-20231212","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1002\/sim.4780120803","article-title":"Kaplan-Meier, marginal or conditional probability curves in summarizing competing risks failure time data?","volume":"12","author":"Pepe","year":"1993","journal-title":"Statist Med"},{"issue":"446","key":"bib23-20231212","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A proportional hazards model for the subdistribution of a competing risk","volume":"94","author":"Fine","year":"1999","journal-title":"J Am Statist Assoc"},{"issue":"5","key":"bib24-20231212","doi-asserted-by":"crossref","first-page":"646","DOI":"10.3171\/2016.4.SPINE151523","article-title":"Re-irradiation stereotactic body radiotherapy for spinal metastases: a multi-institutional outcome analysis","volume":"25","author":"Hashmi","year":"2016","journal-title":"J Neurosurg Spine"},{"issue":"1","key":"bib25-20231212","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.ijrobp.2009.10.056","article-title":"Radiotherapy for patients with metastases to the spinal column: a review of 603 patients at Shizuoka Cancer Center Hospital","volume":"79","author":"Mizumoto","year":"2011","journal-title":"Int J Radiat Oncol"},{"issue":"2","key":"bib26-20231212","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3171\/2010.9.SPINE091005","article-title":"Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient","volume":"14","author":"Sahgal","year":"2011","journal-title":"J Neurosurg Spine"},{"issue":"20","key":"bib27-20231212","doi-asserted-by":"crossref","first-page":"5069","DOI":"10.1002\/cncr.27530","article-title":"Phase 1\/2 trial of single-session stereotactic body radiotherapy for previously unirradiated spinal metastases","volume":"118","author":"Garg","year":"2012","journal-title":"Cancer"},{"issue":"3","key":"bib28-20231212","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.ijrobp.2018.06.047","article-title":"Imaging-based outcomes for 24\u00a0Gy in 2 daily fractions for patients with de novo spinal metastases treated with spine stereotactic body radiation therapy (SBRT)","volume":"102","author":"Tseng","year":"2018","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"3","key":"bib29-20231212","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1016\/j.ijrobp.2008.09.020","article-title":"Stereotactic body radiotherapy is effective salvage therapy for patients with prior radiation of spinal metastases","volume":"74","author":"Sahgal","year":"2009","journal-title":"Int J Radiat Oncol"},{"key":"bib30-20231212","article-title":"Spinal cord dose tolerance to stereotactic body radiation therapy","author":"Sahgal","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"5-6","key":"bib31-20231212","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1159\/000091992","article-title":"Hypofractionated stereotactic radiation therapy for skull base and upper cervical chordoma and chondrosarcoma: preliminary results","volume":"83","author":"Gwak","year":"2005","journal-title":"Stereotact Funct Neurosurg"},{"issue":"27","key":"bib32-20231212","doi-asserted-by":"crossref","first-page":"3426","DOI":"10.1200\/JCO.2013.50.1411","article-title":"Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score","volume":"31","author":"Sahgal","year":"2013","journal-title":"J Clin Oncol"},{"issue":"2","key":"bib33-20231212","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.ijrobp.2009.07.1727","article-title":"Stereotactic radiosurgery for treatment of spinal metastases recurring in close proximity to previously irradiated spinal cord","volume":"78","author":"Choi","year":"2010","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"5","key":"bib34-20231212","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1016\/j.ijrobp.2010.08.012","article-title":"Stereotactic body radiotherapy reirradiation for recurrent epidural spinal metastases","volume":"81","author":"Mahadevan","year":"2011","journal-title":"Int J Radiat Oncol Biol Phys"}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/neurosurgery\/article-pdf\/87\/4\/816\/33903564\/nyaa109.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyaa109","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:56:12Z","timestamp":1786121772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyaa109"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,6]]},"references-count":33,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyaa109","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,6]]}}}