Dose-escalated radiotherapy with simultaneous integrated boost for bone metastases in selected patients with assumed favorable prognosis
Short title: Radiation therapy with simultaneous integrated boost for bone metastases
Introduction: SBRT concepts for dose escalation are increasingly used for bone metastases in patients with oligometastatic or oligoprogressive disease. For metastases that are not suitable for SBRT-regimens, a treatment with 30/40 Gy with simultaneous integrated boost (SIB) in 10 fractions represents a possible regimen. The aim of this study was to investigate the feasibility of this concept and the acute and subacute toxicities.
Materials and methods: Clinical records for dose-escalated radiation therapy of all consecutive patients treated with this regimen were evaluated retrospectively (24 patients with 28 target volumes for oncologic outcomes and 25 patients with 28 target volumes for treatment feasibility and dose parameters analysis). Analysis of radiotherapy plans included size of target volumes and dose parameters for target volumes and organs at risk. Acute and subacute toxicities were evaluated according to CTCAE V4.0.
Results: The most common localization was the spine (71.4%). The most common histology was prostate cancer (45.8%). Oligometastatic or oligoprogressive disease was the indication for dose-escalated radiotherapy in 19/24 patients (79.2%). Treatment was feasible with all patients completing the radiation therapy. Acute toxicity grade 1 was documented in 36.0% of the patients. During the follow up, one patient was operated due to bone instability. The 1-year local control and patient-related progression-free survival were 90.0%±6.7% and 33.3±11.6% respectively.
Conclusion: Dose-escalated hypofractionated radiotherapy with simultaneous integrated boost for bone metastases resulted in good local control with limited acute toxicities. Only one patient required surgical intervention. The regimen represents an alternative to SBRT in selected patients.
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Copyright (c) 2022 Vlatko Potkrajcic, Arndt-Christian Mueller, Bettina Frey, Daniel Zips, Ruediger Hoffmann, Sandra Frantz, Verena Warm, Frank Paulsen, Franziska Eckert
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