{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T23:46:24Z","timestamp":1788565584192,"version":"build-2803163510"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>This study is a multi-institutional pooled analysis specific to imaging-based local control of spinal metastases in patients previously treated with conventional external beam radiation therapy (cEBRT) and then treated with re-irradiation stereotactic body radiotherapy (SBRT) to the spine as salvage therapy, the largest such study to date.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors reviewed cases involving 215 patients with 247 spinal target volumes treated at 7 institutions. Overall survival was calculated on a patient basis, while local control was calculated based on the spinal target volume treated, both using the Kaplan-Meier method. Local control was defined as imaging-based progression within the SBRT target volume. Equivalent dose in 2-Gy fractions (EQD2) was calculated for the cEBRT and SBRT course using an \u03b1\/\u03b2 of 10 for tumor and 2 for both spinal cord and cauda equina.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The median total dose\/number of fractions of the initial cEBRT was 30 Gy\/10. The median SBRT total dose and number of fractions were 18 Gy and 1, respectively. Sixty percent of spinal target volumes were treated with single-fraction SBRT (median, 16.6 Gy and EQD2\/10 = 36.8 Gy), and 40% with multiple-fraction SBRT (median 24 Gy in 3 fractions, EQD2\/10 = 36 Gy). The median time interval from cEBRT to re-irradiation SBRT was 13.5 months, and the median duration of patient follow-up was 8.1 months. Kaplan-Meier estimates of 6- and 12-month overall survival rates were 64% and 48%, respectively; 13% of patients suffered a local failure, and the 6- and 12-month local control rates were 93% and 83%, respectively. Multivariate analysis identified Karnofsky Performance Status (KPS) &lt; 70 as a significant prognostic factor for worse overall survival, and single-fraction SBRT as a significant predictive factor for better local control. There were no cases of radiation myelopathy, and the vertebral compression fracture rate was 4.5%.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Re-irradiation spine SBRT is effective in yielding imaging-based local control with a clinically acceptable safety profile. A randomized trial would be required to determine the optimal fractionation.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.4.spine151523","type":"journal-article","created":{"date-parts":[[2016,6,26]],"date-time":"2016-06-26T01:03:21Z","timestamp":1466903001000},"page":"646-653","source":"Crossref","is-referenced-by-count":87,"title":["Re-irradiation stereotactic body radiotherapy for spinal metastases: a multi-institutional outcome analysis"],"prefix":"10.3171","volume":"25","author":[{"given":"Ahmed","family":"Hashmi","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Guckenberger","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Wuerzburg, Germany;\u00a0"},{"name":"Department of Radiation Oncology, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Kersh","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Riverside Medical Center, Newport News, Virginia;\u00a0"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Gerszten","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick","family":"Mantel","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Wuerzburg, Germany;\u00a0"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inga S.","family":"Grills","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Flickinger","sequence":"additional","affiliation":[{"name":"Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John H.","family":"Shin","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel K.","family":"Fahim","sequence":"additional","affiliation":[{"name":"Neurosurgery, William Beaumont Hospital, Royal Oak, Michigan;\u00a0"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Winey","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Oh","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. 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