Bilsky Mark H, Laufer Ilya, Matros Evan, Yamada Joshua, Rusch Valerie W
Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Plastic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Thorac Surg Clin. 2014 Nov;24(4):423-31. doi: 10.1016/j.thorsurg.2014.07.007. Epub 2014 Sep 11.
The NOMS considerations provide a dynamic decision framework to determine the optimal combination of systemic and radiation therapies and surgery. Generally, NSCLC metastases to the spine require SRS because cEBRT usually fails to provide consistent long-term local control. Patients with spinal cord compression secondary to NSCLC require surgical decompression to safely undergo SRS and to reduce the risk of radiation-induced spinal cord injury. Separation surgery allows spinal cord decompression and spinal stabilization using the posterior approach and, in combination with SRS, has been shown to provide reliable local control with low risk of wound complication or spinal hardware fracture.
NOMS考量提供了一个动态决策框架，以确定全身治疗、放射治疗和手术的最佳组合。一般来说，非小细胞肺癌转移至脊柱需要立体定向放射治疗（SRS），因为常规分割外照射放疗（cEBRT）通常无法提供持续的长期局部控制。继发于非小细胞肺癌的脊髓压迫患者需要手术减压，以便安全地接受SRS并降低放射性脊髓损伤的风险。分离手术采用后路入路实现脊髓减压和脊柱稳定，并且与SRS联合使用时，已证明可提供可靠的局部控制，同时伤口并发症或脊柱内固定物骨折风险较低。
