Boyce-Fappiano David, Gjyshi Olsi, Pezzi Todd A, Allen Pamela K, Solimman Moaaz, Taku Nicolette, Bernstein Michael B, Cabanillas Maria E, Amini Behrang, Tatsui Claudio E, Rhines Laurence D, Wang Xin A, Briere Tina M, Yeboa Debra Nana, Bishop Andrew J, Li Jing, Ghia Amol J
1Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
2Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; and.
J Neurosurg Spine. 2020 Feb 14;32(6):941-949. doi: 10.3171/2019.12.SPINE191269. Print 2020 Jun 1.
Patients with metastatic thyroid cancer have prolonged survival compared to those with other primary tumors. The spine is the most common site of osseous involvement in cases of metastatic thyroid cancer. As a result, obtaining durable local control (LC) in the spine is crucial. This study aimed to evaluate the efficacy of spine stereotactic radiosurgery (SSRS) in patients with metastatic thyroid cancer.
Information on patients with metastatic thyroid cancer treated with SSRS for spinal metastases was retrospectively evaluated. SSRS was delivered with a simultaneous integrated boost technique using single- or multiple-fraction treatments. LC, defined as stable or reduced disease volume, was evaluated by examining posttreatment MRI, CT, and PET studies.
A total of 133 lesions were treated in 67 patients. The median follow-up duration was 31 months. Dose regimens for SSRS included 18 Gy in 1 fraction, 27 Gy in 3 fractions, and 30 Gy in 5 fractions. The histology distribution was 36% follicular, 33% papillary, 15% medullary, 13% Hurthle cell, and 3% anaplastic. The 1-, 2-, and 5-year LC rates were 96%, 89%, and 82%, respectively. The median overall survival (OS) was 43 months, with 1-, 2-, and 5-year survival rates of 86%, 74%, and 44%, respectively. There was no correlation between the absolute biological equivalent dose (BED) and OS or LC. Patients with effective LC had a trend toward improved OS when compared to patients who had local failure: 68 versus 28 months (p = 0.07). In terms of toxicity, 5 vertebral compression fractures (2.8%) occurred, and only 1 case (0.6%) of greater than or equal to grade 3 toxicity (esophageal stenosis) was reported.
SSRS is a safe and effective treatment option with excellent LC and minimal toxicity for patients with metastatic thyroid cancer. No association with increased radiation dose or BED was found, suggesting that such patients can be effectively treated with reduced dose regimens.
与其他原发性肿瘤患者相比，转移性甲状腺癌患者的生存期更长。脊柱是转移性甲状腺癌骨转移最常见的部位。因此，实现脊柱的持久局部控制（LC）至关重要。本研究旨在评估脊柱立体定向放射外科（SSRS）治疗转移性甲状腺癌患者的疗效。
回顾性评估接受SSRS治疗脊柱转移瘤的转移性甲状腺癌患者的信息。SSRS采用同步整合加量技术，进行单次或多次分割治疗。通过治疗后的MRI、CT和PET检查评估LC，定义为疾病体积稳定或缩小。
67例患者共治疗133个病灶。中位随访时间为31个月。SSRS的剂量方案包括1次分割18 Gy、3次分割27 Gy和5次分割30 Gy。组织学分布为滤泡状36%、乳头状33%、髓样15%、嗜酸性细胞13%和未分化3%。1年、2年和5年的LC率分别为96%、89%和82%。中位总生存期（OS）为43个月，1年、2年和5年生存率分别为86%、74%和44%。绝对生物等效剂量（BED）与OS或LC之间无相关性。与局部失败的患者相比，LC有效的患者OS有改善趋势：68个月对28个月（p = 0.07）。在毒性方面，发生了5例椎体压缩骨折（2.8%），仅报告了1例（0.6%）≥3级毒性（食管狭窄）。
对于转移性甲状腺癌患者，SSRS是一种安全有效的治疗选择，具有出色的LC且毒性极小。未发现与辐射剂量增加或BED相关，表明此类患者可采用降低剂量方案进行有效治疗。
