Proton SBRT for Spinal Metastasis

Last updated: April 27, 2026
Sponsor: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Overall Status: Active - Recruiting

Phase

N/A

Condition

Neoplasm Metastasis

Treatment

Spinal Proton SBRT

Clinical Study ID

NCT06895564
J2463
IRB00441921
  • Ages > 18
  • All Genders

Study Summary

This is a single-arm pilot study of proton stereotactic body radiotherapy (SBRT) for nonhematologic spinal metastasis in patients with complex lesions that are unable to be effectively treated with standard of care photon SBRT defined as inability to develop a photon SBRT plan that achieves adequate coverage (≥80% planning treatment volume (PTV) coverage)) with a prescription dose of 30 Gy in 5 fractions.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  1. Histologic proof or unequivocal cytologic proof of nonhematologic malignancy. Thismay be obtained from either the primary or any metastatic site.

  2. Participants must have radiographic evidence of spinal metastasis on MRI.

  3. Participants must have a complex case that is unable to be effectively treated withphoton SBRT, defined as inability to develop a photon SBRT plan that achievesadequate coverage (≥80% PTV coverage) with a prescription dose of 30 Gy in 5fractions. Such cases include:

  4. Extensive paraspinal disease

  5. Reirradiation setting

  6. Epidural extension (Bilsky grade ≥1c)

  7. Age ≥ 18 years.

  8. Eastern Cooperative Oncology Group (ECOG) performance status ≤2 (Karnofsky >60%).

  9. Patients of childbearing potential (male or female) must practice adequatecontraception due to possible harmful effects of radiation therapy on an unbornchild.

  10. Patients must have the ability to understand and the willingness to sign a writteninformed consent document.

  11. All patients must be informed of the investigational nature of this study and mustbe given written informed consent in accordance with institutional and federalguidelines.

Exclusion

Exclusion Criteria:

  1. Participants may not have a spinal metastases case amenable to standard of carephoton SBRT planning techniques that achieve ≥80% PTV coverage with a prescriptiondose of 30 Gy in 5 fractions.

  2. Patients who are unable to receive MRIs will be excluded from the study since MRIswill be critical in treatment planning.

  3. Uncontrolled intercurrent illness including, but not limited to ongoing or activeinfection, symptomatic congestive heart failure, unstable angina pectoris, cardiacarrhythmia, or psychiatric illness/social situations that would limit compliancewith study requirements.

Study Design

Total Participants: 12
Treatment Group(s): 1
Primary Treatment: Spinal Proton SBRT
Phase:
Study Start date:
April 22, 2025
Estimated Completion Date:
May 31, 2030

Study Description

Spine metastases are common with a prevalence of up to 30-50% among patients with a cancer diagnosis. As cancer survivorship improves, durable local control is essential to decrease the risk of pain and neurologic deficits that are associated with spinal metastasis. SBRT for these tumors has demonstrated overall local control rates of approximately 80-90% in the largest published series.

Emerging data highlight the importance of dose escalation for local control in SBRT for spinal metastases. The spinal cord is often the dose limiting structure in patients with spinal metastasis; however, achieving sufficiently high dose and acceptable target coverage while meeting dose constraints of other organs at risk (OARs) such as the small bowel or kidneys also poses a significant technical challenge when using current SBRT modalities for complex cases (e.g., extensive paraspinal disease, epidural disease, disease abutting the kidneys, re-irradiation setting). Maintaining safety is the first priority such that complex cases in current practice often require significant target volume under-coverage in order to meet organ at risk dose constraints, increasing the risk of progression and its associated neurologic morbidity and mortality.

To attempt to improve OAR sparing, proton SBRT has been utilized in other disease sites including prostate, non-small cell lung cancer, and liver. The unique qualities of proton beam therapy may improve target coverage while maintaining OAR sparing in cases where current practice with photon SBRT would require a limited dose and/or under-coverage of the target, both of which are associated with an increased risk of tumor progression.

Connect with a study center

  • Johns Hopkins Hospital

    Baltimore, Maryland 21287
    United States

    Active - Recruiting

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