Zeng K Liang, Sahgal Arjun, Tseng Chia-Lin, Myrehaug Sten, Soliman Hany, Detsky Jay, Atenafu Eshetu G, Lee Young, Campbell Mikki, Maralani Pejman, Husain Zain A
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Neurosurgery. 2021 Apr 15;88(5):971-979. doi: 10.1093/neuros/nyaa583.
Patient selection is critical for spine stereotactic body radiotherapy (SBRT) given potential for serious adverse effects and the associated costs.
To identify prognostic factors associated with dying within 3 mo, or living greater than 3 yr, following spine SBRT, to better inform patient selection.
Patients living ≤3 mo after spine SBRT and >3 yr after spine SBRT were identified, and multivariable regression analyses were performed. We report serious late toxicities observed, including vertebral compression fractures (VCF) and plexopathy.
A total of 605 patients (1406 spine segments) were treated from 2009 to 2018. A total of 51 patients (8.4%) lived ≤3 mo, and 79 patients (13%) survived >3 yr. Significant differences in baseline features were observed. On multivariable analysis, nonbreast/prostate primaries (odds ratio [ORs]: 28.8-104.2, P = .0004), eastern cooperative oncology group (ECOG) ≥2 (OR: 23.7, 95% CI: 3.2-177, P = .0020), polymetastatic disease (OR: 6.715, 95% CI: 1.89-23.85, P = .0032), painful lesions (OR: 3.833-8.898, P = .0118), and paraspinal disease (OR: 2.874, 95% CI: 1.118-7.393, P = .0288) were prognostic for ≤3 mo survival. The 3- and 5-yr rates of VCF were 10.4% and 14.4%, respectively, and 3- and 5-yr rates of plexopathy were 2.2% and 5.1%, respectively. A single duodenal perforation was observed, and there was no radiation myelopathy events.
Shorter survival after spine SBRT was seen in patients with less radiosensitive histologies (ie, not breast or prostate), ECOG ≥2, and polymetastatic disease. Pain and paraspinal disease were also associated with poor survival. Fractionated spine SBRT confers a low risk of late serious adverse events.
鉴于脊柱立体定向体部放疗（SBRT）存在严重不良反应及相关成本的可能性，患者选择至关重要。
确定脊柱SBRT后3个月内死亡或存活超过3年的相关预后因素，以便更好地指导患者选择。
确定脊柱SBRT后存活≤3个月和>3年的患者，并进行多变量回归分析。我们报告观察到的严重晚期毒性反应，包括椎体压缩骨折（VCF）和神经丛病变。
2009年至2018年共治疗605例患者（1406个脊柱节段）。共有51例患者（8.4%）存活≤3个月，79例患者（13%）存活>3年。观察到基线特征存在显著差异。多变量分析显示，非乳腺/前列腺原发性肿瘤（比值比[OR]：28.8 - 104.2，P = .0004）、东部肿瘤协作组（ECOG）≥2（OR：23.7，95%置信区间：3.2 - 177，P = .0020）、多部位转移疾病（OR：6.715，95%置信区间：1.89 - 23.85，P = .0032）、疼痛性病变（OR：3.833 - 8.898，P = .0118）和椎旁疾病（OR：2.874，95%置信区间：1.118 - 7.393，P = .0288）是3个月内生存的预后因素。VCF的3年和5年发生率分别为10.4%和14.4%，神经丛病变的3年和5年发生率分别为2.2%和5.1%。观察到1例十二指肠穿孔，未发生放射性脊髓病事件。
放射敏感性较低的组织学类型（即非乳腺或前列腺）、ECOG≥2和多部位转移疾病的患者在脊柱SBRT后生存期较短。疼痛和椎旁疾病也与生存不良有关。分次脊柱SBRT导致晚期严重不良事件的风险较低。
