Mesko Shane, Deegan Brian J, D'Souza Neil M, Ghia Amol J, Chapman Bhavana V, Amini Behrang, McAleer Mary Frances, Wang Xin A, Brown Paul D, Tatsui Claudio E, Rhines Laurence, Li Jing
Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Radiation Oncology, Mays Cancer Center, University of Texas, San Antonio, USA.
Cureus. 2019 May 23;11(5):e4742. doi: 10.7759/cureus.4742.
Despite aggressive primary treatment, up to 13.5% of patients diagnosed with pheochromocytoma may develop metastases, most often affecting the axial skeleton. Given that systemic therapy options are often inadequate, local therapy remains the cornerstone of palliation for these patients. Historically poor responses to standard fractionated radiotherapy have led to the consideration of stereotactic radiosurgery as an option to overcome potential radioresistance and provide durable local control of these tumors. Here we report our institutional experience in treating spine metastases from pheochromocytoma with spine stereotactic radiosurgery (SSRS).
Our clinical databases were retrospectively reviewed for patients with metastatic pheochromocytoma treated with SSRS from 2000-2017. Seven patients with 16 treated metastatic spinal lesions were identified. Local control was evaluated using magnetic resonance imaging (MRI). Pain and symptom data were assessed to evaluate toxicity using Common Terminology Criteria for Adverse Events (CTCAE) v4.03. The Kaplan-Meier method was used to assess local control and overall survival (OS).
Median follow-up for treated lesions was 11 months (range 2.2 - 70.8). Most lesions were treated to a dose of 27 Gy in three fractions (62.5%). Other fractionation schemes included 24 Gy in one fraction (25%), 16 Gy in one fraction (6.3%), and 18 Gy in three fractions (6.3%). Treatment sites included the cervical spine (18.8%), thoracic spine (37.5%), lumbar spine (31.3%), and sacrum (12.5%). The crude local control rate was 93.7%, with one thoracic spine lesion progressing 20.7 months after treatment with 24 Gy in one fraction. Kaplan-Meier OS rates at 1 and 2 years after SSRS were 71.4% and 42.9%, respectively. Most common toxicities included acute grade 1-2 pain and fatigue. There was one case of vertebral fracture in a cervical spine lesion treated to 27 Gy in three fractions, which was managed non-surgically.
Very few studies have explored the use of SSRS in metastatic pheochromocytoma. Our data suggest this modern radiation modality is effective, safe, and provides durable local control to palliate symptoms and potentially limit further metastatic seeding. Larger patient numbers and longer follow-up will further define the role of SSRS as a treatment option in these patients.
尽管进行了积极的初始治疗，但高达13.5%被诊断为嗜铬细胞瘤的患者可能会发生转移，最常累及中轴骨骼。鉴于全身治疗方案往往不足，局部治疗仍然是这些患者姑息治疗的基石。历史上对标准分割放疗的反应较差，因此立体定向放射外科被视为一种克服潜在放射抵抗并持久局部控制这些肿瘤的选择。在此，我们报告我们机构使用脊柱立体定向放射外科（SSRS）治疗嗜铬细胞瘤脊柱转移的经验。
我们回顾性分析了2000年至2017年接受SSRS治疗的转移性嗜铬细胞瘤患者的临床数据库。确定了7例患者的16个接受治疗的转移性脊柱病变。使用磁共振成像（MRI）评估局部控制情况。使用不良事件通用术语标准（CTCAE）v4.03评估疼痛和症状数据以评估毒性。采用Kaplan-Meier方法评估局部控制和总生存期（OS）。
治疗病变的中位随访时间为11个月（范围2.2 - 70.8个月）。大多数病变接受了27 Gy分三次照射的剂量（62.5%）。其他分割方案包括单次24 Gy（25%）、单次16 Gy（6.3%）和分三次18 Gy（6.3%）。治疗部位包括颈椎（18.8%）、胸椎（37.5%）、腰椎（31.3%）和骶骨（12.5%）。粗略的局部控制率为93.7%，其中一个胸椎病变在单次24 Gy治疗后20.7个月进展。SSRS后1年和2年的Kaplan-Meier总生存率分别为71.4%和42.9%。最常见的毒性包括1 - 2级急性疼痛和疲劳感。有1例颈椎病变接受分三次27 Gy治疗后发生椎体骨折，经非手术处理。
很少有研究探讨SSRS在转移性嗜铬细胞瘤中的应用。我们的数据表明，这种现代放疗方式有效、安全，能持久地局部控制以缓解症状并可能限制进一步的转移播散。更大规模的患者数量和更长时间的随访将进一步明确SSRS作为这些患者治疗选择的作用。
