Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway.
Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
Strahlenther Onkol. 2018 May;194(5):365-374. doi: 10.1007/s00066-018-1266-6. Epub 2018 Jan 23.
Improved survival of patients with spinal bone metastases has resulted in an increased number of referrals for retreatment and repeat reirradiation.
A consortium of expert radiation oncologists (RO) has been established with the aim of providing treatment recommendations for challenging clinical scenarios for which there are no established guidelines. In this case, a patient developed local progression of a T5 vertebral lesion after two prior courses of palliative radiotherapy (time interval >12 months, assumed cumulative biologically equivalent dose in 2‑Gy fractions [EQD2] for spinal cord [alpha/beta 2 Gy] 75 Gy). Expert recommendations were tabulated with the aim of providing guidance.
Five of seven RO would offer a third course of radiotherapy, preferably with advanced techniques such as stereotactic radiotherapy. However, the dose-fractionation concepts were heterogeneous (3-20 fractions) and sometimes adjusted to different options for systemic treatment. All five RO would compromise target volume coverage to reduce the dose to the spinal cord. Definition of the spinal cord planning-organ-at-risk volume was heterogeneous. All five RO limited the EQD2 for spinal cord. Two were willing to accept more than 12.5 Gy and the highest EQD2 was 19 Gy.
The increasing body of literature about bone metastases and spinal cord reirradiation has encouraged some expert RO to offer palliative reirradiation with cumulative cord doses above 75 Gy EQD2; however, no consensus was achieved. Strategies for harmonization of clinical practice and development of evidence-based dose constraints are discussed.
脊柱骨转移患者的生存率提高导致需要更多的治疗和重复再放疗。
一个由专家放射肿瘤学家组成的联盟已经成立，旨在为没有既定指南的具有挑战性的临床情况提供治疗建议。在这种情况下，一位患者在两次姑息性放疗后（时间间隔>12 个月，假设脊髓 2-Gy 分数 [α/β 2Gy] 的累积生物等效剂量 [EQD2] 为 75Gy）发生 T5 椎体病变局部进展。专家建议被制表，旨在提供指导。
7 位 RO 中有 5 位会提供第三次放疗，最好采用立体定向放疗等先进技术。然而，剂量分割概念存在差异（3-20 次分割），有时根据不同的全身治疗方案进行调整。所有 5 位 RO 都会降低脊髓的剂量来减少靶区的覆盖。脊髓计划器官危险区体积的定义存在差异。所有 5 位 RO 都限制脊髓的 EQD2。有 2 位愿意接受超过 12.5Gy，最高的 EQD2 为 19Gy。
关于骨转移和脊髓再放疗的文献越来越多，鼓励一些专家 RO 提供累积脊髓剂量超过 75Gy EQD2 的姑息性再放疗；然而，尚未达成共识。讨论了协调临床实践和制定基于证据的剂量限制的策略。
