Local control and outcomes associated with proton spine hypofractionated radiation therapy.

Authors

Christopher B Jackson, Daniel S Higginson, Haibo Lin, Dennis Mah, Justin Haseltine, Boris A Mueller, Adam M Schmitt, Max Vaynrub, W Christopher Newman, Rabih Bou-Nassif, Eric Lis, Ori Barzilai, Mark H Bilsky, Yoshiya Yamada

Published in

International journal of radiation oncology, biology, physics. Aug 19, 2026. Epub Aug 19, 2026.

Abstract

Little is known about the long-term outcomes of patients with spinal metastases treated with proton hypofractionated radiotherapy (pHFRT), particularly in the setting of re-irradiation (re-RT).
This is a retrospective cohort study of patients treated between 2015-2023 utilizing pHFRT (≤10 fractions). All patients received follow-up magnetic resonance imaging at least 1 month after treatment. Outcomes of interest included local failure (LF), defined radiographically, as well as long-term adverse events.
A total of 52 patients treated to 58 lesions met inclusion criteria. Median follow-up after RT was 14 months (IQR 8-25). The most common dose-fractionation scheme was 40 Gy in 5 fractions (n=47, 81%). There were 10 cases of first-time RT utilizing protons (17%), whereas 25 courses (43%) were second-time re-RT, 19 courses (33%) were third-time re-RT and 4 courses (6.9%) were fourth-time re-RT. Median cumulative equivalent dose in 2-Gy fractions (EQD2) was 115 Gy (IQR 91-153). The 1-year LF rate was 10% (95% confidence interval (CI) 4-20%), and the 2-year LF rate was 22% (95% CI 12-35%). There were 5 grade (G) 3 adverse events, including radiation myelitis (1), esophageal fistula (1), esophageal stricture (1), wound dehiscence (1), and bowel necrosis (1). All G3 adverse events occurred in patients who received 3-4 overlapping courses of RT. There were no G4-5 adverse events.
PHFRT is associated with excellent local control in this large cohort of heavily re-irradiated patients (81% re-RT). G3 adverse events were limited to patients who received 3-4 overlapping courses of RT.

PMID:
42617886
Bibliographic data and abstract were imported from PubMed on 20 Aug 2026.

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