University of Virginia / Riverside, Radiosurgery Center, Newport News, VA, USA.
Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA.
J Neurooncol. 2020 Jun;148(2):381-388. doi: 10.1007/s11060-020-03534-4. Epub 2020 May 15.
Stereotactic radiosurgery (SRS) has shown durable local control for the treatment of metastatic diseasespinal metastases. Multilevel disease or epidural or paraspinal involvement present challenges to achieving local control, and this study aims to analyze treatment outcomes for such lesions.
Patients treated at a single institution with SRS to the spine from 2010-2018 were retrospectively reviewed. Inclusion criteria required clinical follow-up with either a pain assessment or imaging study. Bulky spine metastasis was defined as consisting of multilevel disease or epidural or paraspinal tumor involvement.
54 patients treated for 62 lesions met inclusion criteria. 42 treatments included at least two vertebrae, and 21 and 31 had paraspinal and epidural involvement, respectively. Treatment regimens had a median 24 Gy in 3 fractions to a volume of 37.75 cm3. Median follow-up was 14.36 months, with 5 instances (8%) of local failure. Median overall survival was 13.32 months. Pain improvement was achieved in 47 treatments (76%), and pain improved with treatment (p < 0.0001). Severe pain (HR = 3.08, p = 0.05), additional bone metastases (HR = 4.82, p = 0.05), and paraspinal involvement (HR = 3.93, p < 0.005) were predictive for worse overall survival. Kaplan-Meier analysis demonstrated that prior chemotherapy (p = 0.03) and additional bone metastases (p = 0.02) were predictive of worse overall survival. Grade < 3 toxicity was observed in 19 cases; no grade ≥ 3 side effects were observed.
SRS can effectively treat bulky metastases to the spine, resulting in improvement of pain with minimal toxicity. Severe pain independently predicts for worse overall survival, indicating that treatment prior to worsening of pain is strongly recommended.
立体定向放射外科（SRS）已显示出对转移性脊柱转移瘤的持久局部控制作用。多发病变或硬膜外或椎旁累及是实现局部控制的挑战，本研究旨在分析此类病变的治疗结果。
回顾性分析 2010 年至 2018 年在一家机构接受 SRS 治疗的脊柱转移瘤患者。纳入标准要求有临床随访，包括疼痛评估或影像学研究。脊柱转移瘤体积大定义为多发病变或硬膜外或椎旁肿瘤累及。
54 例患者共 62 个病灶符合纳入标准。42 例治疗包括至少 2 个椎体，21 例和 31 例分别有椎旁和硬膜外累及。治疗方案为 24 Gy/3 次分割，体积为 37.75 cm3。中位随访时间为 14.36 个月，局部失败 5 例（8%）。中位总生存期为 13.32 个月。47 例（76%）疼痛得到改善，且疼痛随治疗而改善（p<0.0001）。严重疼痛（HR=3.08，p=0.05）、额外的骨转移（HR=4.82，p=0.05）和椎旁累及（HR=3.93，p<0.005）与总体生存较差相关。Kaplan-Meier 分析表明，先前的化疗（p=0.03）和额外的骨转移（p=0.02）与总体生存较差相关。19 例发生 <3 级毒性，无 ≥3 级副作用。
SRS 可有效治疗脊柱转移瘤体积大的患者，在最小毒性的情况下改善疼痛。严重疼痛独立预测总体生存较差，表明强烈建议在疼痛恶化前进行治疗。
