Gerszten Peter C, Burton Steven A, Belani Chandra P, Ramalingam Suresh, Friedland David M, Ozhasoglu Cihat, Quinn Annette E, McCue Kevin J, Welch William C
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Cancer. 2006 Dec 1;107(11):2653-61. doi: 10.1002/cncr.22299.
Spinal metastases are a common source of pain as well as neurologic deficit in patients with lung cancer. Metastases from lung cancer traditionally have been believed to be relatively responsive to radiation therapy. However, conventional external beam radiotherapy lacks the precision to allow delivery of large single-fraction doses of radiation and simultaneously limit the dose to radiosensitive structures such as the spinal cord. The current study evaluated the efficacy of single-fraction radiosurgery for the treatment of spinal lung cancer metastases.
In the current prospective cohort evaluation, 87 lung cancer metastases to the spine in 77 patients were treated with a single-fraction radiosurgery technique with a follow-up period of 6 to 40 months (median, 12 months). The indication for radiosurgery treatment was pain in 73 cases, as a primary treatment modality in 7 cases, for radiographic tumor progression in 4 cases, and for progressive neurologic deficit in 3 cases.
Tumor volume ranged from 0.2 to 264 cm(3) (mean, 25.7 cm(3)). The maximum tumor dose was maintained at 15 to 25 grays (Gy) (mean, 20 Gy; median, 20 Gy). No radiation-induced toxicity occurred during the follow-up period. Long-term axial and radicular pain improvement occurred in 65 of 73 patients (89%) who were treated primarily for pain. Long-term radiographic tumor control was observed in all patients who underwent radiosurgery as their primary treatment modality or for radiographic tumor progression.
Spinal radiosurgery was found to be feasible, safe, and clinically effective for the treatment of spinal metastases from lung cancer. The results of the current study indicate the potential of radiosurgery in the treatment of patients with spinal lung metastases, especially those with solitary sites of spine involvement, to improve long-term palliation.
脊柱转移瘤是肺癌患者疼痛和神经功能缺损的常见原因。传统上认为肺癌转移瘤对放射治疗相对敏感。然而，传统的外照射放疗缺乏精确性，无法在给予大分割单次剂量放疗的同时，将脊髓等放射敏感结构的剂量限制在安全范围内。本研究评估了单次分割放射外科治疗脊柱肺癌转移瘤的疗效。
在本次前瞻性队列评估中，采用单次分割放射外科技术治疗了77例患者的87处脊柱肺癌转移瘤，随访时间为6至40个月（中位数为12个月）。放射外科治疗的适应证包括73例疼痛患者、7例作为主要治疗方式的患者、4例影像学肿瘤进展患者以及3例进行性神经功能缺损患者。
肿瘤体积范围为0.2至264 cm³（平均25.7 cm³）。最大肿瘤剂量维持在15至25格雷（Gy）（平均20 Gy；中位数20 Gy）。随访期间未发生放射诱导的毒性反应。73例以疼痛为主要治疗目的的患者中，65例（89%）长期轴向和神经根性疼痛得到改善。所有接受放射外科作为主要治疗方式或因影像学肿瘤进展而接受治疗的患者均实现了长期影像学肿瘤控制。
发现脊柱放射外科治疗肺癌脊柱转移瘤是可行、安全且临床有效的。本研究结果表明，放射外科在治疗脊柱肺癌转移患者，尤其是脊柱受累为孤立部位的患者方面具有改善长期姑息治疗的潜力。
