Myositis following spine radiosurgery for metastatic disease: a case series

Author:

Lockney Dennis T.1,Jia Angela Y.23,Lis Eric4,Lockney Natalie A.2,Liu Chengbao5,Hopkins Benjamin6,Higginson Daniel S.2,Yamada Yoshiya2,Laufer Ilya6,Bilsky Mark6,Schmitt Adam M.2

Affiliation:

1. Department of Neurosurgery, University of Florida, Gainesville, Florida;

2. Departments of Radiation Oncology,

3. Department of Medicine, Weill Cornell Medical College, New York, New York

4. Radiology,

5. Pathology, and

6. Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York; and

Abstract

OBJECTIVESpinal stereotactic body radiation therapy (SBRT) has emerged as an attractive method to deliver high doses of radiation to oligometastatic spinal tumors with radioresistant histology. Because SBRT is a palliative therapy, attention to potential radiation toxicities is paramount when counseling patients. The objective of this study was to report radiation-induced myositis after SBRT, a previously undescribed complication.METHODSA total of 667 patients received 891 spine SBRT treatments (either 24 Gy in 1 fraction or 27 Gy in 3 fractions) from 2011 to 2016 and underwent retrospective review. Eleven patients were identified as having radiographic evidence of myositis following SBRT. Clinical and pathologic results were collected, including receipt of anti–vascular endothelial growth factor (VEGF) therapy, radiation dose, equivalent dose in 2-Gy fractions (EQD2), biologically effective dose (BED), and volume of muscle treated. Treatment toxicities were classified according to the Common Terminology Criteria for Adverse Events (CTCAE; version 4.03). Univariate statistical analyses were performed to evaluate the relationships between radiation fractionation schedule and myositis and between anti-VEGF therapy and myositis.RESULTSThe cumulative incidence of myositis was 1.9% at 1 year. The median of the mean dose administered to muscle with myositis was 17.5 Gy. The median EQD2 was 55.1 Gy, and the median BED was 82.7 Gy. The median time to the development of clinical symptoms was 1.4 months, while the median time to imaging evidence was 4.7 months. Two patients (18.2%) had CTCAE grade 3 complications. Single-fraction spine SBRT (HR 4.5, 95% CI 1.2–16.9; p = 0.027) was associated with increased risk of developing myositis whereas receipt of anti-VEGF therapy was not (HR 2.2, 95% CI 0.6–7.1; p = 0.2).CONCLUSIONSRadiation myositis following spinal radiosurgery is a rare but important complication. Single-fraction treatment schedules may be associated with increased risk of myositis but should be validated in a larger series.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

Reference54 articles.

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3. Side effects of chemotherapy. Case 2. Radiation recall reaction induced by gemcitabine;Castellano;J Clin Oncol,2000

4. Radiation recall dermatitis induced by erlotinib;Dauendorffer;J Am Acad Dermatol,2009

5. Levofloxacin-induced radiation recall dermatitis: a case report and a review of the literature;Wernicke;Clin Breast Cancer,2010

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