Stereotactic Body Radiation Therapy (SBRT) for Tumors Near the Spinal Cord

Not Applicable

Completed

Brief Summary: The purpose of this research study is to determine if Stereotactic Body Radiation Therapy (SBRT) is a good way to treat tumors near the spinal cord. Patients will either receive a single treatment or 25 days of treatment given once-a-day, Monday through Friday for about 5 continuous weeks. Our protocol uses life expectancy, patient preference, and tumor size to determine whether SBRT is delivered with 1 or 25 treatments. The single treatment dose is 15 Gy. The 25 treatment group is 70 Gy at 2.8 Gy/treatment.

Detailed Description: This protocol is a study of the use of Stereotactic Body Radiation Therapy (SBRT) for all types of primary or metastatic tumors near the spinal cord. The major goal of this study is to evaluate the efficacy and toxicity of a specific SBRT program in a prospective manner. The main outcome variables in this study are pain and neurologic function.

A major issue in delivering SBRT is the number of treatment sessions. There are advantages and disadvantages to both single and multi treatment programs. In this protocol, patients are offered SBRT with either a single treatment or 25 treatment days. This study is not designed to compare different SBRT schedules. A single treatment program is more convenient and likely to relieve symptoms sooner than a multi-session program. A program with 25 treatments may produce better long-term results. Our protocol uses life expectancy, patient preference, and tumor size to determine whether SBRT is delivered with 1 or 25 treatments.

Recruitment & Eligibility

Inclusion Criteria

Informed consent to participate in this protocol
Patient of all ages are eligible
All tumor types are eligible
Patients with prior spine radiotherapy and/or surgery to the involved area are eligible
The tumor target must be visible on MRI or CT scan
Stereotactic Body Radiation Therapy (SBRT) on this protocol may produce a better outcome than conventional radiotherapy

Exclusion Criteria

Patients who are likely to have a satisfactory outcome with surgical resection, embolization, or radiofrequency ablation without the addition of radiotherapy
Tumor size, shape, or location is such that it is not reasonable to think the patient may benefit from SBRT as given in this protocol
The full extent of the tumor cannot be visualized on MRI or CT scan
Delaying radiotherapy for the time that it takes to start SBRT may compromise outcome compared to starting conventional radiotherapy immediately
The patient cannot be positioned reproducibly due to pain or other factors

Arm && Interventions

Group	Intervention	Description
Single Treatment Group	Stereotactic Body Radiation Therapy	15 Gy dose in one stereotactic body radiation treatment
25 Treatments Group	Stereotactic Body Radiation Therapy	25 treatments, given once a day, Monday through Friday for about five weeks; Dose: 70 Gy at 2.8 Gy/treatment

Primary Outcome Measures

Name	Time	Method
Toxicity	2 yrs	Toxicities were graded using the RTOG-EORTC (Radiation Therapy Oncology Group-European Organization for Research and Treatment of Cancer) system and a descriptive system with which we coded any complication as mild, moderate, or severe based on our informal assessment of the complication's effect on overall quality of life. We assessed toxicity as "acute" meaning during treatment and "late" meaning several months after treatment ended.

Secondary Outcome Measures

Name	Time	Method
Local Control	1 year	Number of tumor sites with no evidence of progression of tumor at the site of radiosurgery
Neurologic Function	2 years	Number of patients with a change in neurological function of those who presented with a neurologic deficit from tumor compression. The McCormack score was noted for each patient and the interval change was determined informally as no neurological deficit, better, worse, or unchanged as noted below.
Pain Relief	12 weeks	Number of patients who reported pain at baseline and reported experienced relief after treatment. Pain was defined on a 10 point scale with 0 being no pain and 10 being worst pain imaginable. Pain relief is defined as reporting a lower level of pain than that reported at baseline.
Overall One Year Survival	One year	Number of patients alive at one year after treatment