Meleis Ahmed, Jhawar Sachin R, Weiner Joseph P, Majmundar Neil, Mahtabfar Aria, Lin Yong, Jabbour Salma, Danish Shabbar, Goyal Sharad
Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
World Neurosurg. 2019 Feb;122:e198-e205. doi: 10.1016/j.wneu.2018.09.210. Epub 2018 Oct 9.
In the setting of spinal metastases with epidural cord compression, radiosurgery is often only considered when there is sufficient separation between the epidural disease and the spinal cord. However, in patients who are nonsurgical candidates or those who prefer nonoperative management, there may be a benefit from stereotactic body radiation therapy, even when the epidural target is closer than the traditionally referenced 3 mm distance from the spinal cord. The purpose of this retrospective study is to evaluate our institution's experience in treating 20 such patients.
We reviewed records of all patients treated with stereotactic body radiation therapy for spinal metastases at our institution from January 2010 to January 2016, with follow-up through December 2016. The primary end point was local progression of disease. Local progression was defined as clear radiographic disease growth on follow-up imaging or worsening clinical symptoms in the absence of evidence for radiation myelopathy.
Local control was obtained in 55% of patients meeting these criteria without a single case of radiation myelitis. Most patients with disease progression were able to undergo additional local treatment.
Although local control was less than expected when compared with spine radiosurgery with adequate separation between the target and spinal cord, this treatment appears to be a viable option in the nonsurgical candidate.
在伴有硬膜外脊髓压迫的脊柱转移瘤情况下，通常仅当硬膜外病变与脊髓之间有足够的间距时才考虑进行放射外科治疗。然而，对于不适合手术的患者或那些倾向于非手术治疗的患者，即使硬膜外靶区距离脊髓比传统参考的3毫米更近，立体定向体部放射治疗可能也有益处。这项回顾性研究的目的是评估我们机构治疗20例此类患者的经验。
我们回顾了2010年1月至2016年1月在我们机构接受立体定向体部放射治疗脊柱转移瘤的所有患者的记录，并随访至2016年12月。主要终点是疾病的局部进展。局部进展定义为随访影像学上明确的疾病生长或在无放射性脊髓病证据的情况下临床症状恶化。
符合这些标准的患者中有55%获得了局部控制，且无一例放射性脊髓炎病例。大多数疾病进展的患者能够接受额外的局部治疗。
尽管与靶区和脊髓之间有足够间距的脊柱放射外科治疗相比，局部控制率低于预期，但这种治疗似乎是不适合手术患者的一种可行选择。
