Katsoulakis Evangelia, Kumar Kiran, Laufer Ilya, Yamada Yoshiya
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY.
Department of Radiation Oncology, Stanford University, Stanford, CA.
Semin Radiat Oncol. 2017 Jul;27(3):209-217. doi: 10.1016/j.semradonc.2017.03.004. Epub 2017 Mar 16.
Patients with metastatic disease including polymetastatic, oligometastatic, and oligorecurrent spinal lesions have extended life expectancy secondary to improvements in systemic agents, and thus require durable local control of spine metastases. Stereotactic body radiotherapy (SBRT), which uses highly conformal treatment planning techniques coupled with image-guided technology, has enabled the safe delivery of tumor-ablative doses of radiotherapy. The NOMS decision framework has been developed as a tool to aid in the determination of the optimal treatment of spinal metastases, incorporating radiosurgery, separation surgery, stabilization techniques, and conventional radiation. Tumor radiosensitivity is critical in determining appropriateness of radiosurgery. In general, higher radiation doses provide significant, more durable tumor control, whether single-fraction or hypofractionated regimens are used. Spine SBRT can provide a high likelihood of durable tumor control with very low rates of serious toxicity, and careful attention should be given to dose constraints of organs at risk. Here, we review the indications for spine SBRT via the NOMS decision framework and provide practical information to the radiation oncologist regarding spine radiosurgery.
患有转移性疾病（包括多部位转移、寡转移和寡复发性脊柱病变）的患者，由于全身治疗药物的改进，预期寿命得以延长，因此需要对脊柱转移瘤进行持久的局部控制。立体定向体部放疗（SBRT）采用高度适形的治疗计划技术并结合图像引导技术，能够安全地给予肿瘤消融剂量的放疗。NOMS决策框架已被开发出来，作为一种辅助工具，用于确定脊柱转移瘤的最佳治疗方案，包括放射外科手术、分离手术、稳定技术和传统放疗。肿瘤放射敏感性对于确定放射外科手术的适用性至关重要。一般来说，无论采用单次分割还是低分割方案，更高的放射剂量都能提供显著且更持久的肿瘤控制。脊柱SBRT能够以极低的严重毒性发生率实现持久肿瘤控制的高可能性，并且应特别关注危及器官的剂量限制。在此，我们通过NOMS决策框架回顾脊柱SBRT的适应证，并为放射肿瘤学家提供有关脊柱放射外科手术的实用信息。
