de Moraes Fabio Ynoe, Taunk Neil Kanth, Laufer Ilya, Neves-Junior Wellington Furtado Pimenta, Hanna Samir Abdallah, Carvalho Heloisa de Andrade, Yamada Yoshiya
Hospital Sírio-Libanês, Departamento de Radioterapia, São Paulo/, SP, Brasil.
Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York/NY, USA.
Clinics (Sao Paulo). 2016 Feb;71(2):101-9. doi: 10.6061/clinics/2016(02)09.
Many cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is based on intensity-modulated radiotherapy, image guidance and rigid immobilization. Spinal radiosurgery is an increasingly utilized treatment method that improves local control and pain relief after delivering ablative doses of radiation. Here, we present a review highlighting the use of spinal radiosurgery for the treatment of metastatic tumors of the spine. The data used in the review were collected from both published studies and ongoing trials. We found that spinal radiosurgery is safe and provides excellent tumor control (up to 94% local control) and pain relief (up to 96%), independent of histology. Extensive data regarding clinical outcomes are available; however, this information has primarily been generated from retrospective and nonrandomized prospective series. Currently, two randomized trials are enrolling patients to study clinical applications of fractionation schedules spinal Radiosurgery. Additionally, a phase I clinical trial is being conducted to assess the safety of concurrent stereotactic body radiotherapy and ipilimumab for spinal metastases. Clinical trials to refine clinical indications and dose fractionation are ongoing. The concomitant use of targeted agents may produce better outcomes in the future.
许多癌症患者会发生脊柱转移。局部控制对于预防神经功能损害和缓解疼痛很重要。立体定向体部放疗或脊柱放射外科是一种用于脊柱转移的新型放射治疗技术，它可以在将高剂量辐射传递到肿瘤的同时，将传递到健康邻近组织的辐射降至最低。这种治疗基于调强放疗、图像引导和刚性固定。脊柱放射外科是一种越来越常用的治疗方法，在给予消融剂量的辐射后可改善局部控制和疼痛缓解。在此，我们发表一篇综述，重点介绍脊柱放射外科在治疗脊柱转移性肿瘤中的应用。综述中使用的数据来自已发表的研究和正在进行的试验。我们发现脊柱放射外科是安全的，并且无论组织学类型如何，都能提供出色的肿瘤控制（局部控制率高达94%）和疼痛缓解（疼痛缓解率高达96%）。关于临床结果有大量数据；然而，这些信息主要来自回顾性和非随机前瞻性系列研究。目前，两项随机试验正在招募患者，以研究分次放疗方案在脊柱放射外科中的临床应用。此外，一项I期临床试验正在进行，以评估立体定向体部放疗与伊匹单抗联合治疗脊柱转移的安全性。正在进行完善临床适应症和剂量分割的临床试验。未来同时使用靶向药物可能会产生更好的结果。
