Stereotactic radiosurgery for spinal cholangiocarcinoma metastases: Clinical outcomes and the role of biologically effective dose thresholds.

Authors

Juan J Cardona, Fred C Lam, Mohamed F Al Gharyani, Yusuke S Hori, Deya Abu-Reesh, Louisa Ustrzynski, Sara C Emrich, Armine Tayag, Xuejun Gu, Erqi L Pollom, Scott G Soltys, Gordon Li, Atman Desai, Melanie Hayden Gephart, David J Park, Steven D Chang

Published in

Neurosurgical review. Volume 49. Issue 1. Jul 30, 2026. Epub Jul 30, 2026.

Abstract

Stereotactic radiosurgery (SRS) has emerged as a promising modality for improving local tumor control (LTC); however, data on its use for spinal metastases (SM) specifically from cholangiocarcinoma remain limited. In this single-institution retrospective analysis, we aimed to evaluate the safety and efficacy of SRS for SM from cholangiocarcinoma, exploring the role of biologically effective dose (BED) thresholds. Demographic, clinical, radiographic, and dosimetric variables, including Bilsky grade, Karnofsky Performance Status (KPS), and BED, were collected. The treatment response was assessed using a combination of radiologic, metabolic, and clinical criteria. Survival outcomes were calculated using Kaplan-Meier methods, and statistical analyses accounted for lesion clustering within patients. Seventeen SM identified in eight patients (mean age 68 years; SD± 8.2 years) were analyzed. The mean lesion volume at the time of treatment was 37.4 cm³ (SD± 23.8 cm³) and the median prescription dose was 20 Gy (IQR = 20-28 Gy). In exploratory comparisons, lesions with Bilsky ≥1c showed lower 3-month clinical response stability than lower-grade lesions (25% vs. 85% stable; p = 0.04). Patients with KPS > 70 tended to receive higher BED₁₀ values, although this exploratory comparison did not reach statistical significance (p = 0.05). Most notably, no local progression occurred in lesions treated with BED₁₀ >60 Gy (0/5) versus 25% progression (3/12) with BED₁₀ ≤60 Gy, representing a hypothesis-generating signal that warrants further investigation. CTCAE grade ≥ 3 adverse events were not evidenced after the treatment. A 1-year LTC rate of 86% along with a median overall survival of 12 months, was achieved using SRS. This largest series to date demonstrates that SRS provides durable LTC with a favorable safety profile for spinal cholangiocarcinoma metastases. Bilsky grade and KPS may inform clinical decision-making, while BED₁₀ thresholds show a promising hypothesis-generating signal for LTC that requires validation in larger studies.

PMID:
42527634
Bibliographic data and abstract were imported from PubMed on 30 Jul 2026.

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