Single- vs. Two-Fraction Spine Stereotactic Radiosurgery for the Treatment of Vertebral Metastases

  • STATUS
    Recruiting
  • participants needed
    130
  • sponsor
    Case Comprehensive Cancer Center
Updated on 19 February 2024
metastasis
sarcoma
x-rays
spinal cord
relieve pain
karnofsky performance status
stereotactic radiosurgery
bone scan
external beam radiation therapy
neurologic symptoms
compression fracture
soft tissue sarcomas
mri spine
melanoma
renal cell carcinoma

Summary

Spine radiosurgery (SRS) utilizes advanced treatment planning with focused x-rays to deliver one to four high dose treatments to the spine to help relieve pain and/or neurologic symptoms. Spine SRS uses special equipment to position the participant and guide the focused beams toward the area to be treated and away from normal tissue.

One of the side effects of spine SRS is the development of vertebral compression fractures, many of which are not painful. The goal of this study is to compare the effects, good and/or bad, of spine SRS given in 1 or 2 treatments. Our main goal is to find out which approach will reduce the chances of developing vertebral compression fractures.

Description

The primary objective of this study is to establish the non-inferiority in vertebral compression fracture (VCF) incidence at 6 months between single-fraction and two-fraction sSRS.

Other objectives are to to evaluate the 12-month impact of single- and two-fraction sSRS on local control (LC), pain control (PC), quality of life (QOL), and toxicity (specifically, pain flare, radiation esophagitis/laryngitis/pharyngitis, and radiation myelitis)

This study is planned as a two-arm randomized phase II trial to establish non-inferiority of single fraction sSRS compared to two-fraction sSRS. Approximately 130 participants will be enrolled in this trial; 65 participants in each arm:

  • Group 1: If you are assigned to this group, you will undergo spine radiosurgery in a single (1) session.
  • Group 2: If you are assigned to this group, you will undergo spine radiosurgery in two (2) sessions.

Details
Condition Spine Metastases, Spine Stereotactic Radiosurgery (sSRS)
Age 18-100 years
Treatment Diagnostic MRI, Planning MRI, Simulation CT, QOL assessment, Brief pain inventory (BPI), sSRS in 1 fraction, sSRS in 2 fraction
Clinical Study IdentifierNCT04218617
SponsorCase Comprehensive Cancer Center
Last Modified on19 February 2024

Eligibility

Yes No Not Sure

Inclusion Criteria

Karnofsky Performance Status (KPS) 70
RPA class 1 (KPS >70 AND controlled systemic disease) or RPA Class 2 (KPS >70, uncontrolled systemic disease OR KPS 70, age 54, no visceral metastases)44 (see Appendix II)
Vertebral metastases from C3 to L5 based on bone scan, CT, PET, or MRI
Vertebral metastases must be (1) solitary, (2) at two contiguous levels, or (3) a maximum of three separate sites, with a maximum of two contiguous levels
Radioresistant metastases are permitted (including sarcomas, melanomas, and renal cell carcinomas)
Patients with epidural disease are permitted so long as there is no cord compression
Paraspinal extension is permitted, so long as the paraspinal component is 5 cm
Multiple small metastatic lesions (<20% vertebral body involvement) of no clinical correlate are permitted, and not included in the irradiated segments as per RTOG 0631
History and physical within four weeks of registration
Negative pregnancy test within four weeks of registration for women of childbearing potential
Diagnostic spine MRI with and without contrast within four weeks of registration
Neurological exam within four weeks of registration to rule out rapid neurological decline. Mild to moderate neurological deficits are acceptable, as long as distance between lesion and spinal cord is 3 mm
Patients may have prior EBRT at the index site
Informed consent of the participant

Exclusion Criteria

Lesions at C1-2 or S1-Coccyx
Hematologic malignancies including lymphoma and myeloma
Multiple primary cancers
Primary neoplasms of the spine
Prior corpectomy, kyphoplasty/vertebroplasty, or instrumentation at the site of planned sSRS
Spinal cord compression
Paraspinal mass >5 cm
Patients with rapid neurologic decline
Bony retropulsion resulting in neurologic deficit
Patients with contraindications to MRI
Patients allergic to intravenous contrast for MRI or CT
Patients with emergent spinal cord compression
Patients with mechanical instability of the spine
Patients with active connective tissue disease
Patients who previously underwent sSRS to the vertebrae of interest
Patients with diffuse or multilevel metastatic spinal disease with >20% involvement of vertebral bodies, defined as involvement of >5 vertebral levels
Inability to participate in study activities due to physical or mental limitations
Inability or unwillingness to return for all required follow-up visits and imaging
Inability to deliver sSRS, either 18 Gy in one fraction, or 24 Gy in two fractions
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