Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Biostatistics, University Health Network, Toronto, Ontario, Canada.
Neurosurgery. 2019 Nov 1;85(5):605-612. doi: 10.1093/neuros/nyy393.
The unique anatomy and biomechanical features of the cervical spine and sacrum may impact treatment outcomes following spine stereotactic body radiotherapy (SBRT). Current data for spine metastases are not specific for these locations.
To report imaging-based SBRT outcomes to cervical and sacral metastases.
We retrospectively reviewed our prospective spine SBRT database for cervical and sacral metastases. Patients were followed at 2- to 3-mo intervals with a clinical visit and full spine magnetic resonance imaging (MRI) and we report overall survival (OS), vertebral compression fracture (VCF), and MR imaging-based local control (LC) rates.
Fifty-two patients and 93 treated spinal segments were identified. Fifty-six segments were within the cervical spine and 37 within the sacrum, the median follow-up was 14.4 and 19.5 mo, and the median total dose/number of fractions was 24 Gy/2, respectively. Cumulative LC at 1 and 2 yr were 94.5% and 92.7% for the cervical cohort, and 86.5% and 78.7% in the sacral cohort, respectively. Lack of posterior spinal element involvement in the cervical spine (P < .0001) and absence of epidural disease (hazard ratio 0.275, 95% confidence interval 0.076-0.989, P = .048) in the sacral cohort predicted LC. Median OS was 16.3 and 28.5 mo in the cervical spine and sacrum cohorts, respectively. Two cases of sacral VCF, 1 brachial plexopathy, and 1 lumbar-sacral plexopathy were observed.
Although high rates of LC were observed, strategies specific to the sacrum may require further optimization.
颈椎和骶骨的独特解剖结构和生物力学特征可能会影响脊柱立体定向体放射治疗（SBRT）后的治疗效果。目前针对脊柱转移瘤的数据并不特定于这些部位。
报告基于影像学的脊柱 SBRT 治疗颈椎和骶骨转移瘤的结果。
我们回顾性地审查了我们前瞻性的脊柱 SBRT 数据库中颈椎和骶骨转移瘤的病例。患者每隔 2-3 个月进行一次临床随访，并进行全脊柱磁共振成像（MRI）检查，我们报告总生存率（OS）、椎体压缩性骨折（VCF）和基于 MRI 的局部控制（LC）率。
共纳入 52 例患者和 93 个治疗的脊柱节段。56 个节段位于颈椎，37 个位于骶骨，中位随访时间分别为 14.4 个月和 19.5 个月，中位总剂量/分割次数分别为 24 Gy/2 次。颈椎组 1 年和 2 年的累积 LC 率分别为 94.5%和 92.7%，骶骨组分别为 86.5%和 78.7%。颈椎组中无脊柱后部结构受累（P<0.0001）和骶骨组中无硬膜外疾病（风险比 0.275，95%置信区间 0.076-0.989，P=0.048）与 LC 相关。颈椎和骶骨组的中位 OS 分别为 16.3 个月和 28.5 个月。观察到 2 例骶骨 VCF、1 例臂丛神经病和 1 例腰骶丛神经病。
尽管观察到了较高的 LC 率，但可能需要进一步优化针对骶骨的策略。
