Epstein-Peterson Zachary D, Sullivan Adam, Krishnan Monica, Chen Julie T, Ferrone Marco, Ready John, Baldini Elizabeth H, Balboni Tracy
Harvard Medical School, Boston, Massachusetts.
Harvard School of Public Health, Boston, Massachusetts.
Pract Radiat Oncol. 2015 Sep-Oct;5(5):e531-e536. doi: 10.1016/j.prro.2015.02.006. Epub 2015 Apr 6.
To evaluate patterns and predictors of local failure in patients undergoing postoperative radiation therapy (RT) for osseous metastases.
Patients undergoing postoperative RT for bone metastases between June 2008 and January 2012 were retrospectively reviewed. Patterns of local failure were assessed, and Fine and Gray's univariable and multivariable analyses (MVA) were used to evaluate factors associated with local progression, including dose intensity of RT (biological equivalent dose, BED, Gy10) and percent coverage of the surgical hardware by the RT fields. Additional predictors were similarly assessed, including patient (eg, age, performance status), disease (eg, tumor type, metastasis site), and treatment (eg, interval from surgery to RT) characteristics.
A total of 82 cases were followed for a median of 4.3 months (11.5 months among living patients) after treatment completion. Median BED was 39 Gy10 (range, 14-60), and RT fields covered an average of 71% (standard deviation, 26%) of the hardware. Fourteen cases (17%) experienced local progression. Although most (71%) failures occurred within the RT fields, 29% occurred marginally or out of field, but adjacent to surgical hardware. Increasing coverage of the surgical hardware by RT fields was associated with a reduced risk of local failure in MVA (hazard ratio [HR], 0.10; 95% confidence interval [CI], 0.012-0.82; P = .03), whereas a greater risk of failure was seen with increasing time between surgery and RT (HR, 1.03; 95% CI, 1.01-1.06; P = .01). Extremity rather than spinal site trended toward a greater risk of failure but did not reach significance (HR, 3.79; 95% CI, 0.96-14.89; P = .057). BED ≥39 Gy10 did not predict local failure (P = .51) in MVA.
Current strategies achieve good outcomes after postoperative RT for osseous metastases. Greater coverage of the surgical hardware with RT fields and avoiding delays between surgery and postoperative RT should be considered to reduce recurrence risk for patients with bone metastases requiring surgical stabilization.
评估接受骨转移术后放射治疗（RT）患者的局部失败模式及预测因素。
回顾性分析2008年6月至2012年1月期间接受骨转移术后RT的患者。评估局部失败模式，并采用Fine和Gray的单变量及多变量分析（MVA）来评估与局部进展相关的因素，包括RT的剂量强度（生物等效剂量，BED，Gy10）以及RT野对手术植入物的覆盖百分比。类似地评估其他预测因素，包括患者特征（如年龄、体能状态）、疾病特征（如肿瘤类型、转移部位）和治疗特征（如手术至RT的间隔时间）。
共82例患者在治疗完成后接受了中位时间为4.3个月（存活患者为11.5个月）的随访。中位BED为39 Gy10（范围14 - 60），RT野平均覆盖植入物的71%（标准差26%）。14例（17%）患者出现局部进展。尽管大多数（71%）失败发生在RT野内，但29%发生在边缘或野外，但与手术植入物相邻。MVA分析显示，RT野对手术植入物覆盖范围增加与局部失败风险降低相关（风险比[HR]，0.10；95%置信区间[CI]，0.012 - 0.82；P = 0.03），而手术至RT的时间间隔增加则失败风险更高（HR，1.03；95% CI，1.01 - 1.06；P = 0.01）。四肢而非脊柱部位的失败风险有增加趋势，但未达到显著水平（HR，3.79；95% CI，0.96 - 14.89；P = 0.057）。MVA分析中BED≥39 Gy10不能预测局部失败（P = 0.51）。
当前策略在骨转移术后RT后取得了良好疗效。对于需要手术固定的骨转移患者，应考虑增加RT野对手术植入物的覆盖范围并避免手术与术后RT之间的延迟，以降低复发风险。
