立体定向体部放疗后溶骨性肾细胞癌脊柱转移所致椎体压缩骨折的风险：一项多机构研究。
Risk of vertebral compression fracture specific to osteolytic renal cell carcinoma spinal metastases after stereotactic body radiotherapy: A multi-institutional study.
作者信息
Thibault Isabelle, Atenafu Eshetu G, Chang Eric, Chao Sam, Ameen Al-Omair, Zhou Stephanie, Boehling Nicholas, Balagamwala Ehsan H, Cunha Marcelo, Cho John, Angelov Lilyana, Brown Paul D, Suh John, Rhines Laurence D, Fehlings Michael G, Sahgal Arjun
机构信息
Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada.
Department of Biostatistics, University Health Network, University of Toronto, 610 University Ave, Toronto, Ontario, M5T 2M9, Canada.
出版信息
J Radiosurg SBRT. 2015;3(4):297-305.
PURPOSE
Determine the risk of vertebral compression fracture (VCF) following stereotactic body radiotherapy (SBRT), specific to osteolytic renal cell carcinoma (RCC) spinal metastases, and associated predictive factors.
METHODS
187 RCC osteolytic spinal tumor segments in 116 patients obtained from a multi-institutional pooled database were reviewed. Each segment was evaluated according to the Spinal Instability Neoplastic Score (SINS).
RESULTS
The median follow-up was 8.0 months. 34 VCF (34/187, 18%) were observed and median time to VCF was 2.4 months. VCF was observed in 43% (10/23), 24% (4/17) and 14% (20/147) of segments treated with 24Gy/fraction (fx), 20-23Gy/fx and ≤19Gy/fx, respectively. Multivariate analysis identified dose per fx (p=0.005), baseline VCF (p<0.001) and spinal misalignment (p=0.002) as predictors of VCF. Prior conventional radiotherapy (p=0.029) was found to be protective.
CONCLUSIONS
18% of osteolytic RCC spinal metastases fractured post-SBRT. The presence of a baseline fracture, spinal mal-alignment and treatment with ≥20Gy/fx predicted for VCF.
目的
确定立体定向体部放疗（SBRT）后椎体压缩骨折（VCF）的风险，该风险特定于溶骨性肾细胞癌（RCC）脊柱转移瘤，并确定相关的预测因素。
方法
回顾了从多机构汇总数据库中获取的116例患者的187个RCC溶骨性脊柱肿瘤节段。根据脊柱不稳定肿瘤评分（SINS）对每个节段进行评估。
结果
中位随访时间为8.0个月。观察到34例VCF（34/187，18%），VCF的中位发生时间为2.4个月。分别在接受24Gy/分次（fx）、20 - 23Gy/fx和≤19Gy/fx治疗的节段中观察到VCF的比例为43%（10/23）、24%（4/17）和14%（20/147）。多变量分析确定每次分次剂量（p = 0.005）、基线VCF（p < 0.001）和脊柱排列不齐（p = 0.002）为VCF的预测因素。发现先前的传统放疗（p = 0.029）具有保护作用。
结论
18%的溶骨性RCC脊柱转移瘤在SBRT后发生骨折。基线骨折、脊柱排列不齐以及≥20Gy/fx的治疗可预测VCF。
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