Chang J H, Gandhidasan S, Finnigan R, Whalley D, Nair R, Herschtal A, Eade T, Kneebone A, Ruben J, Foote M, Siva S
Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.
Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Clin Oncol (R Coll Radiol). 2017 Jul;29(7):e119-e125. doi: 10.1016/j.clon.2017.02.004. Epub 2017 Feb 23.
To report multicentre outcomes of patients with spinal oligometastases treated with stereotactic ablative body radiotherapy (SABR). The primary objective was to estimate the widespread failure-free survival (WFFS) at 2 years - defined as freedom from metastases not amenable to local salvage therapy and death.
Patients with one to three metastases treated with spinal SABR between January 2010 and July 2014 at four academic institutions were included in this retrospective review. The median dose/fractionation was 24 Gy (range 16-52.5 Gy) in two fractions (range one to three) and the median biologically effective dose (α/β=10) was 52.5 Gy (range 40-144.4 Gy). The WFFS, overall survival, freedom from local progression and toxicity rates were described using Kaplan-Meier statistics.
In total, 60 patients with 72 spinal metastases were analysed. The median follow-up was 21 months. Patients had a median age of 66 years, Eastern Cooperative Oncology Group performance 0-1 in 97% and metachronous oligometastases in 85%. The 1 and 2 year WFFS rates were 67% (95% confidence interval 55-80) and 59% (95% confidence interval 47-75), respectively. The 1 and 2 year overall survival rates were 90% (95% confidence interval 83-98) and 76% (95% confidence interval 64-91), respectively. The 1 and 2 year freedom from local progression were 92% (95% confidence interval 85-99) and 86% (95% confidence interval 75-99), respectively. There were four cases (6.7%) of vertebral compression fracture and no cases of radiation myelopathy.
Despite the use of relatively low biological doses respecting spinal cord constraints, SABR results in excellent 2 year local control rates with low morbidity. Through careful selection of patients with oligometastases, most patients are alive and free from widespread metastases at 2 years. This cohort warrants further investigation in clinical trials of SABR.
报告接受立体定向消融体部放疗（SABR）的脊柱寡转移患者的多中心治疗结果。主要目标是评估2年时的广泛无失败生存期（WFFS），定义为无不适于局部挽救治疗的转移灶且无死亡。
本回顾性研究纳入了2010年1月至2014年7月期间在四家学术机构接受脊柱SABR治疗的1至3个转移灶患者。中位剂量/分割为24Gy（范围16 - 52.5Gy），分2次分割（范围1至3次），中位生物等效剂量（α/β = 10）为52.5Gy（范围40 - 144.4Gy）。使用Kaplan - Meier统计方法描述WFFS、总生存期、无局部进展生存期和毒性发生率。
共分析了60例有72个脊柱转移灶的患者。中位随访时间为21个月。患者中位年龄66岁，97%的东部肿瘤协作组（ECOG）体能状态评分为0 - 1，85%为异时性寡转移。1年和2年的WFFS率分别为67%（95%置信区间55 - 80）和59%（95%置信区间47 - 75）。1年和2年的总生存率分别为90%（95%置信区间83 - 98）和76%（95%置信区间64 - 91）。1年和2年的无局部进展率分别为92%（95%置信区间85 - 99）和86%（95%置信区间75 - 99）。有4例（6.7%）发生椎体压缩骨折，无放射性脊髓病病例。
尽管在考虑脊髓限制的情况下使用了相对较低的生物剂量，但SABR仍能带来优异的2年局部控制率且发病率低。通过仔细选择寡转移患者，大多数患者在2年时存活且无广泛转移。该队列值得在SABR的临床试验中进一步研究。
