Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
Clin Oncol (R Coll Radiol). 2018 Feb;30(2):85-92. doi: 10.1016/j.clon.2017.11.005. Epub 2017 Dec 6.
Vertebral bodies remain one of the most common sites of metastases. In cases where surgical intervention is not indicated or appropriate, conventional external radiation therapy (cEBRT) has been the standard treatment modality. Unfortunately, cEBRT is typically limited, with low complete response and poor local control rates. Disappointing results with re-irradiation using cEBRT highlight the need for innovative salvage therapeutic strategies, such as stereotactic body radiotherapy. A detailed description of this complex treatment strategy is outlined, as is a systematic review of current literature. Although data are limited to single institution series, re-irradiation has consistently been found to be effective with respect to local control (1 year rates range from 66 to 90%) and pain response. Importantly, the treatment is shown to be safe, with the crude rate of radiation myelopathy <1% and a rate of vertebral compression fracture of 12%. As further research and technologic advances continue to refine therapy, stereotactic body radiotherapy is now a recommended option for the treatment of previously irradiated vertebral body metastases.
椎体仍然是转移最常见的部位之一。在不适合或不建议进行手术干预的情况下，传统的外部放射治疗（cEBRT）一直是标准的治疗方式。不幸的是，cEBRT 通常具有局限性，完全缓解率和局部控制率较低。使用 cEBRT 进行再照射的结果令人失望，这凸显了需要创新的挽救性治疗策略，如立体定向体部放射治疗。本文详细描述了这种复杂的治疗策略，并对当前的文献进行了系统回顾。尽管数据仅限于单机构系列，但再照射在局部控制方面（1 年的局部控制率范围为 66%至 90%）和疼痛反应方面一直被证明是有效的。重要的是，该治疗方法被证明是安全的，放射性脊髓病的发生率<1%，椎体压缩性骨折的发生率为 12%。随着进一步的研究和技术进步继续完善治疗，立体定向体部放射治疗现在是治疗先前照射的椎体转移瘤的推荐选择。
