Ozdemir Yurday, Torun Nese, Guler Ozan Cem, Yildirim Berna Akkus, Besen Ali A, Yetisken Aylin Gunesli, Onal H Cem, Topkan Erkan
Department of Radiation Oncology, Baskent University Medical Faculty, Kisla Saglik Yerleskesi, 01120 Adana, Turkey.
Department of Nuclear Medicine, Baskent University Medical Faculty, Adana, Turkey.
J Bone Oncol. 2019 Jan 24;15:100218. doi: 10.1016/j.jbo.2019.100218. eCollection 2019 Apr.
We aimed to retrospectively assess the incidence of vertebral compression fractures (VCF), examine clinicopathologic factors potentially associated with VCF, and evaluate treatment response in patients who received stereotactic body radiotherapy (SBRT) for spine metastases (spMets).
We identified 78 patients with 125 spMets at baseline and subsequent assessments. Patients received SBRT doses of 16 or 18 Gy. Patients with pre-existing VCF and co-existing local progression were excluded. Spine instability neoplastic score (SINS) was used for spMets categorization. Response to SBRT and VCF were assessed according to the Positron Emission tomography Response Criteria In Solid Tumors (PERCIST) and Genant scores, respectively. Kaplan-Meier analyses were used to assess local control of disease and vertebral compression fracture-free survival (FFS).
We treated 103 cases with single spMets and 11 cases involving double spMets with SBRT. Progressive disease was reported in 3.2% and 8.2% of the cases in the first and last PET/CT reports, respectively. The distribution of treatment response in the remaining patients was: complete response in 30.6% of patients, partial response in 47.1% of patients, and stable disease in 22.3% of patients in the first PET/CT; complete response in 62.3% of patients, partial response in 16.7% of patients, and stable disease in 21% of patients at the last monitoring. Local failures were observed in 15 (12%) of cases. Median SINS was 5 (range: 1-13); majority of patients in our cohort (70.4%) were categorized as stable according to SINS, five (4%) patients had Grade 3 VCF at a median time of 16 months after SBRT (range: 2-22 months), and 60% of VCF occurred after an interval of at least 12 months after SBRT. No bisphosphonate usage was significantly associated with VCF ( = -0.204; = 0.022). Median FFS was 21 months. Univariate analyses indicated that female gender ( < 0.001), bisphosphonate use ( = 0.005), >6 months of bisphosphonates use ( = 0.002), and the lowest vertebral body collapse score ( = 0.023) were associated with higher FFS. Female gender ( = 0.007), >6 months of bisphosphonates usage ( = 0.018), and the lowest vertebral body collapse score ( = 0.044) retained independent significance.
This study demonstrated that spine SBRT with doses of 16-18 Gy promises good local control of disease with acceptable VCF rates. Lowest vertebral body collapse score, female gender, and >6 months of bisphosphonate use were significantly associated with longer FFS.
我们旨在回顾性评估椎体压缩骨折（VCF）的发生率，研究可能与VCF相关的临床病理因素，并评估接受立体定向体部放疗（SBRT）治疗脊柱转移瘤（spMets）患者的治疗反应。
我们在基线及后续评估中确定了78例患有125处spMets的患者。患者接受16或18 Gy的SBRT剂量。排除既往存在VCF和并存局部进展的患者。采用脊柱不稳定肿瘤评分（SINS）对spMets进行分类。分别根据实体瘤正电子发射断层扫描反应标准（PERCIST）和Genant评分评估SBRT反应和VCF。采用Kaplan-Meier分析评估疾病的局部控制和无椎体压缩骨折生存期（FFS）。
我们用SBRT治疗了103例单发spMets和11例多发spMets。在首次和末次PET/CT报告中，分别有3.2%和8.2%的病例出现疾病进展。其余患者的治疗反应分布为：首次PET/CT时，30.6%的患者完全缓解，47.1%的患者部分缓解，22.3%的患者病情稳定；末次监测时，62.3%的患者完全缓解，16.7%的患者部分缓解，21%的患者病情稳定。15例（12%）出现局部失败。SINS中位数为5（范围：1 - 13）；根据SINS，我们队列中的大多数患者（70.4%）被分类为稳定，5例（4%）患者在SBRT后中位时间16个月（范围：2 - 22个月）出现3级VCF，60%的VCF发生在SBRT后至少12个月的间隔期。双膦酸盐的使用与VCF无显著相关性（ = -0.204； = 0.022）。FFS中位数为21个月。单因素分析表明，女性（ < 0.001）、使用双膦酸盐（ = 0.005）、使用双膦酸盐超过6个月（ = 0.002）以及最低椎体塌陷评分（ = 0.023）与较高的FFS相关。女性（ = 0.007）、使用双膦酸盐超过6个月（ = 0.018）以及最低椎体塌陷评分（ = 0.044）具有独立显著性。
本研究表明，16 - 18 Gy剂量的脊柱SBRT有望实现良好的疾病局部控制，且VCF发生率可接受。最低椎体塌陷评分、女性以及使用双膦酸盐超过6个月与更长的FFS显著相关。
