Chang Ung-Kyu, Youn Sang Min, Park Sukh Que, Rhee Chang Hun
Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea.
J Korean Neurosurg Soc. 2009 Dec;46(6):538-44. doi: 10.3340/jkns.2009.46.6.538. Epub 2009 Dec 31.
Primary treatment of spinal metastasis has been external beam radiotherapy. Recent advance of technology enables radiosurgery to be extended to extracranial lesions. The purpose of this study was to determine the clinical effectiveness and safety of stereotactic radiosurgery using Cyberknife in spinal metastasis.
From June, 2002 to December, 2007, 129 patients with 167 spinal metastases were treated with Cyberknife. Most of the patients (94%) presented with pain and nine patients suffered from motor deficits. Twelve patients were asymptomatic. Fifty-three patients (32%) had previous radiation therapy. Using Cyberknife, 16-39 Gy in 1-5 fractions were delivered to spinal metastatic lesions. Radiation dose was not different regarding the tumor pathology or tumor volume.
After six months follow-up, patient evaluation was possible in 108 lesions. Among them, significant pain relief was seen in 98 lesions (91%). Radiological data were obtained in 83 lesions. The mass size was decreased or stable in 75 lesions and increased in eight lesions. Radiological control failure cases were hepatocellular carcinoma (5 cases), lung cancer (1 case), breast cancer (1 case) and renal cell carcinoma (1 case). Treatment-related radiation injury was not detected.
Cyberknife radiosurgery is clinically effective and safe for spinal metastases. It is true even in previously irradiated patients. Compared to conventional radiation therapy, Cyberknife shows higher pain control rate and its treatment process is more convenient for patients. Thus, it can be regarded as a primary treatment modality for spinal metastases.
脊柱转移瘤的主要治疗方法一直是体外放射治疗。技术的最新进展使放射外科能够扩展到颅外病变。本研究的目的是确定使用射波刀进行立体定向放射外科治疗脊柱转移瘤的临床有效性和安全性。
2002年6月至2007年12月，129例患有167处脊柱转移瘤的患者接受了射波刀治疗。大多数患者（94%）表现为疼痛，9例患者存在运动功能障碍。12例患者无症状。53例患者（32%）曾接受过放射治疗。使用射波刀，将16 - 39 Gy的剂量分1 - 5次给予脊柱转移瘤病灶。放射剂量在肿瘤病理或肿瘤体积方面无差异。
随访6个月后，108处病灶可进行患者评估。其中，98处病灶（91%）疼痛明显缓解。83处病灶获得了影像学数据。75处病灶的肿块大小减小或稳定，8处病灶增大。影像学控制失败的病例为肝细胞癌（5例）、肺癌（1例）、乳腺癌（1例）和肾细胞癌（1例）。未检测到与治疗相关的放射损伤。
射波刀放射外科治疗脊柱转移瘤在临床上有效且安全。即使对于先前接受过放疗的患者也是如此。与传统放射治疗相比，射波刀显示出更高的疼痛控制率，且其治疗过程对患者更方便。因此，它可被视为脊柱转移瘤的一种主要治疗方式。
