Retreatment of vertebral mets

[Pewl]

Do any of you have any experience with retreatment of metastatic disease to the vertebrae?

We have a lady with widespread metastatic breast cancer with diffuse bone mets and a large liver met. The vertebral mets were causing excruciating pain so she received 30Gy in 10fx to the spine. Now about a year later the pain is back. She's taking PO pain meds with minimal relief. Do any of you have experience retreating this area with say protons or SBRT?

---

Members don't see this ad.

 

[BraggPeak]

How many levels need to be treated? Is SRS an option where you are?

 

[thesauce]

Take a look at PMID:22608954

 

[ShirleyT]

If it is too many levels for SBRT or you don't have protons, can consider repeat conventional at 20 Gy in 10 fx since she is one year out from her first course. i have done this in five patients with no toxicity.

 

[Palex80]

Nieder has published data on spinal cord reirradiation
PMID: 15708265
PMID: 17084560

I usually treat patients, who relapse > 1 year after 30/10 with 30/2 or 36/1.2 bid.
We have treated around 20 patients with such a schedule and have seen no toxicity so far.

You can of course try to perform IMRT to spare the spinal cord, if your GTV allows that.

I wouldn't try to give her too little dose, if she has a favorable life expectancy or you may end up having the same problem again 1 year later.

 

[Reaganite]

Do any of you have any experience with retreatment of metastatic disease to the vertebrae?

We have a lady with widespread metastatic breast cancer with diffuse bone mets and a large liver met. The vertebral mets were causing excruciating pain so she received 30Gy in 10fx to the spine. Now about a year later the pain is back. She's taking PO pain meds with minimal relief. Do any of you have experience retreating this area with say protons or SBRT?

LOL, so why did you mention spine SBRT?! I know you don't have that!

 

[deleted4401]

There is an excellent review of the literature in this article at the end discussing the spinal cord's resilience and what BED to try to keep it under when re-irradiating it: http://www.ncbi.nlm.nih.gov/pubmed/19640634. The author is first rate.
-S

 

[clinonc]

In the UK most oncologists will recommend 20 Gy 5# as initial treatment in patients of good performance status. This then allows you to retreat with 8 Gy 1#, or sometimes 16 Gy 4#, and keep within tolerance. Good palliation usually seen, and inconvenience to the patient from prolonged treatment schedules kept to a minimum.

 

[Reaganite]

There is an excellent review of the literature in this article at the end discussing the spinal cord's resilience and what BED to try to keep it under when re-irradiating it: http://www.ncbi.nlm.nih.gov/pubmed/19640634. The author is first rate.
-S

I see what you did there. Excellent review article indeed!

 

[deleted4401]

In the Rojo today: http://www.redjournal.org/article/S0360-3016(11)03488-2/abstract

 

[Pewl]

In the Rojo today: http://www.redjournal.org/article/S0360-3016(11)03488-2/abstract

What a serendipitous find!