Outcomes following stereotactic body radiation therapy specific to spinal metastases with paraspinal disease extension: does volume matter?
Bibliographic record
Abstract
OBJECTIVE: Paraspinal involvement has been consistently reported as a negative predictor of local control following stereotactic body radiation therapy (SBRT) for spinal metastases. The aim of this study was to investigate the characteristics of paraspinal disease and determine the impact on outcomes. METHODS: Patients who underwent SBRT for spinal metastases with paraspinal involvement, identified from a single-institutional prospective database, were retrospectively reviewed. Those with prior radiation therapy/surgery were excluded. The treated clinical target volume (CTV) was segmented into paraspinal (CTV_PS), neuroforaminal (CTV_NF), epidural (CTV_EP), and osseous bone (CTV_bone) components. The extent of extraosseous disease was classified according to the involvement of rib, neuroforamina, and muscle. Volume and dosimetric parameters were collected and dichotomized using recursive binary partitioning. The outcomes of interest were the cumulative incidence of local failure (LF), overall survival (OS), and reirradiation rates. RESULTS: One hundred fourteen patients with 125 treated spinal sites were identified. There were 38% (47/125), 66% (82/125), and 19% (24/125) treated spinal sites with involvement of rib, neuroforamina, and muscle, respectively. The median follow-up duration of the cohort was 17.34 months (IQR 7.79-40.11 months). The 12-month and 24-month cumulative incidence rates of LF were 19.5% (95% CI 12.6%-27.4%) and 29.8% (95% CI 21.4%-38.7%), respectively. The 12-month cumulative incidence rates of LF were 12.0% (95% CI 5.9%-20.5%) and 36.3% (95% CI 20.2%-52.6%) for patients with CTV_PS < 42.9 mL and those with ≥ 42.9 mL (p < 0.001), respectively, and 55.6% (95% CI 28.7%-75.8%) and 12.2% (95% CI 6.5%-19.9%) for patients with and without muscle invasion (p = 0.001), respectively. In the multivariable analysis, only CTV_PS remained statistically associated with LF. CTV_PS ≥ 42.9 mL was associated with 2.3 times (95% CI 1.13-4.83, p = 0.02) increased risk of LF compared with CTV_PS < 42.9 mL. The 12-month and 24-month OS rates were 56% (95% CI 47%-65%) and 41% (95% CI 32%-50%), respectively. Patients with an Eastern Cooperative Oncology Group performance status score < 1 and oligometastatic disease (≤ 5 metastases) were associated with better OS in the multivariable analysis. The 12-month and 24-month reirradiation rates were 7.3% (95% CI 3.4%-13.3%) and 16.5% (95% CI 10.2%-24.1%), respectively. CONCLUSIONS: Spinal metastases with high-volume paraspinal involvement were associated with increased risk of LF following SBRT, and strategies to optimize local control are required.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".