Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario.
Department of Radiation Oncology, London Health Sciences Centre, London, Ontario.
Neurosurgery. 2020 Sep 15;87(4):816-822. doi: 10.1093/neuros/nyaa109.
Upon progression after upfront radiotherapy to spinal metastases, low-dose re-irradiation conventional external beam radiation (cEBRT) provides limited clinical benefit. Spine stereotactic body radiotherapy (SBRT) allows for dose escalation in the salvage setting with the potential for improved local control.
To report mature clinical and imaging-based outcomes for salvage SBRT.
A retrospective review was undertaken of consecutive patients with spinal metastases treated with re-irradiation spine SBRT having failed either cEBRT (n = 60 with 1 prior course and n = 17 with 2 or more prior cEBRT courses), or prior SBRT (n = 6) to the same spinal segment. The primary outcome was local failure (LF), and secondary outcomes included overall survival (OS) and the rate of vertebral compression fracture (VCF).
A total of 43 patients with 83 spinal segments treated with salvage SBRT were reviewed. The crude risk of LF was 18%, and actuarial LF rates at 6, 12, and 24 mo were 7%, 14%, and 19%, respectively. The presence of extensive paraspinal disease (hazard ratio [HR] = 7.1, 95% CI 1.5-34) significantly predicted for LF. The median OS was 13.2 (95% CI 6.1-16.3) mo, and the presence of neurological deficits (HR = 4.7, 95% CI 1.8-12.1) and brain metastases (HR = 2.6, 95% CI 1.1-6.3) were significant prognostic factors. The crude risk of VCF was 4%, and radiation myelopathy was not observed.
These data support the safety and efficacy of spinal re-irradiation with SBRT including patients with prior SBRT and multiple courses of prior cEBRT.
在脊柱转移瘤初始放疗进展后，低剂量再放疗常规外束放疗（cEBRT）提供的临床获益有限。脊柱立体定向体部放疗（SBRT）允许在挽救性治疗中进行剂量升级，具有改善局部控制的潜力。
报告挽救性 SBRT 的成熟临床和影像学结果。
对接受再放疗脊柱 SBRT 治疗的脊柱转移瘤患者进行回顾性分析，这些患者在接受 cEBRT 治疗后进展（n=60 例，其中 1 例接受过治疗，n=17 例接受过 2 次或更多次 cEBRT 治疗）或先前 SBRT（n=6 例）治疗后进展，治疗部位相同。主要结局是局部失败（LF），次要结局包括总生存率（OS）和椎体压缩性骨折（VCF）发生率。
共回顾了 43 例患者的 83 个脊柱节段，接受了挽救性 SBRT 治疗。LF 的粗风险为 18%，6、12 和 24 个月的累积 LF 发生率分别为 7%、14%和 19%。广泛的椎旁疾病存在（风险比[HR] = 7.1，95%CI 1.5-34）显著预测 LF。中位 OS 为 13.2（95%CI 6.1-16.3）mo，存在神经功能缺损（HR = 4.7，95%CI 1.8-12.1）和脑转移（HR = 2.6，95%CI 1.1-6.3）是显著的预后因素。VCF 的粗风险为 4%，未观察到放射性脊髓病。
这些数据支持 SBRT 进行脊柱再放疗的安全性和有效性，包括先前接受过 SBRT 和多次 cEBRT 治疗的患者。
