Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada.
Radiat Oncol. 2017 Sep 11;12(1):153. doi: 10.1186/s13014-017-0887-8.
Stereotactic body radiotherapy (SBRT) for vertebral metastases has emerged as a promising technique, offering high rates of symptom relief and local control combined with low risk of toxicity. Nonetheless, local failure or vertebral instability may occur after spine SBRT, generating the need for subsequent surgery in the irradiated region. This study evaluated whether there is an increased incidence of surgical complications in patients previously treated with SBRT at the index level.
Based upon a retrospective international database of 704 cases treated with SBRT for vertebral metastases, 30 patients treated at 6 different institutions were identified who underwent surgery in a region previously treated with SBRT.
Thirty patients, median age 59 years (range 27-84 years) underwent SBRT for 32 vertebral metastases followed by surgery at the same vertebra. Median follow-up time from SBRT was 17 months. In 17 cases, conventional radiotherapy had been delivered prior to SBRT at a median dose of 30 Gy in median 10 fractions. SBRT was administered with a median prescription dose of 19.3 Gy (range 15-65 Gy) delivered in median 1 fraction (range 1-17) (median EQD2/10 = 44 Gy). The median time interval between SBRT and surgical salvage therapy was 6 months (range 1-39 months). Reasons for subsequent surgery were pain (n = 28), neurological deterioration (n = 15) or fracture of the vertebral body (n = 13). Open surgical decompression (n = 24) and/or stabilization (n = 18) were most frequently performed; Five patients (6 vertebrae) were treated without complications with vertebroplasty only. Increased fibrosis complicating the surgical procedure was explicitly stated in one surgical report. Two durotomies occurred which were closed during the operation, associated with a neurological deficit in one patient. Median blood loss was 500 ml, but five patients had a blood loss of more than 1 l during the procedure. Delayed wound healing was reported in two cases. One patient died within 30 days of the operation.
In this series of surgical interventions following spine SBRT, the overall complication rate was 19%, which appears comparable to primary surgery without previous SBRT. Prior spine SBRT does not appear to significantly increase the risk of intra- and post-surgical complications.
立体定向体部放疗（SBRT）治疗脊柱转移瘤是一种很有前途的技术，可实现高缓解率和局部控制率，同时具有低毒性风险。尽管如此，脊柱 SBRT 后仍可能出现局部失败或脊柱不稳，需要在照射区域进行后续手术。本研究评估了先前在指数水平接受 SBRT 治疗的患者在接受手术时是否有更高的手术并发症发生率。
基于 704 例接受 SBRT 治疗脊柱转移瘤的回顾性国际数据库，在 6 家不同机构中确定了 30 例在先前接受 SBRT 治疗的区域接受手术的患者。
30 例患者，中位年龄 59 岁（范围 27-84 岁），32 例脊柱转移瘤接受 SBRT 治疗，随后在同一椎体行手术治疗。SBRT 中位随访时间为 17 个月。在 17 例患者中，在 SBRT 之前曾接受中位剂量 30 Gy（中位数 10 次分割）的常规放疗。SBRT 给予中位处方剂量 19.3 Gy（范围 15-65 Gy），单次分割（范围 1-17）（中位数 EQD2/10=44 Gy）。SBRT 与手术挽救治疗之间的中位时间间隔为 6 个月（范围 1-39 个月）。后续手术的原因是疼痛（n=28）、神经功能恶化（n=15）或椎体骨折（n=13）。最常进行的是开放性减压（n=24）和/或稳定术（n=18）；5 例患者（6 个椎体）仅行椎体成形术，无并发症。一份手术报告明确提到手术过程中出现纤维化并发症。发生 2 例硬脊膜切开术，术中闭合，1 例患者出现神经功能缺损。中位出血量为 500 ml，但 5 例患者术中出血量超过 1 l。2 例报告延迟伤口愈合。1 例患者术后 30 天内死亡。
在本系列 SBRT 后脊柱手术干预中，总体并发症发生率为 19%，似乎与无先前 SBRT 的初次手术相当。先前的脊柱 SBRT 似乎并未显著增加围手术期并发症的风险。
