Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Neurosurgery. 2021 Apr 15;88(5):1021-1027. doi: 10.1093/neuros/nyaa587.
Spine surgery is indicated for select patients with mechanical instability, pain, and/or malignant epidural spinal cord compression, with or without neurological compromise. Stereotactic body radiotherapy (SBRT) is an option for durable local control (LC) for metastatic spine disease.
To determine factors associated with LC and progression-free survival (PFS) for patients receiving postoperative stereotactic spine radiosurgery.
We analyzed consecutive patients from 2013 to 2019 treated with surgical intervention followed by SBRT. Surgical interventions included laminectomy and vertebrectomy. SBRT included patients treated with 1 to 5 fractions of radiosurgery. We analyzed LC, PFS, overall survival (OS), and toxicity. Univariate and multivariate analyses were performed.
A total of 63 patients were treated with a median follow-up of 12.5 mo. Approximately 75% of patients underwent vertebrectomy and 25% underwent laminectomy. One-year cumulative incidence of local failure was 19%. LC was significantly improved for patients receiving radiosurgery ≤40 d from surgery compared to that for patients receiving radiosurgery ≥40 d from surgery, 94% vs 75%, respectively, at 1 yr (P = .03). Patients who received preoperative embolization had improved LC with 1-yr LC of 88% vs 76% for those who did not receive preoperative embolization (P = .037). Significant predictors for LC on multivariate analysis were time from surgery to radiosurgery, higher radiotherapy dose, and preoperative embolization. The 1-yr PFS and OS was 56% and 60%, respectively.
Postoperative radiosurgery has excellent and durable LC for spine metastasis. An important consideration when planning postoperative radiosurgery is minimizing delay from surgery to radiosurgery. Preoperative embolization and higher radiotherapy dose were associated with improved LC warranting further study.
脊柱手术适用于有机械性不稳定、疼痛和/或恶性硬膜外脊髓压迫的特定患者，无论是否存在神经功能障碍。立体定向体部放射治疗（SBRT）是治疗转移性脊柱疾病的持久局部控制（LC）的一种选择。
确定接受术后立体定向脊柱放射外科治疗的患者 LC 和无进展生存期（PFS）的相关因素。
我们分析了 2013 年至 2019 年连续接受手术干预后行 SBRT 治疗的患者。手术干预包括椎板切除术和椎体切除术。SBRT 包括接受 1 至 5 次分次放射外科治疗的患者。我们分析了 LC、PFS、总生存期（OS）和毒性。进行了单变量和多变量分析。
共有 63 例患者接受治疗，中位随访时间为 12.5 个月。约 75%的患者行椎体切除术，25%的患者行椎板切除术。1 年局部失败的累积发生率为 19%。与术后≥40 d 接受放射外科治疗的患者相比，术后≤40 d 接受放射外科治疗的患者 LC 显著提高，1 年时分别为 94%和 75%（P=0.03）。接受术前栓塞治疗的患者 LC 更好，1 年 LC 为 88%，而未接受术前栓塞治疗的患者为 76%（P=0.037）。多变量分析中 LC 的显著预测因素是手术至放射外科治疗的时间、更高的放射治疗剂量和术前栓塞。1 年的 PFS 和 OS 分别为 56%和 60%。
术后放射外科治疗脊柱转移瘤具有极好和持久的 LC。计划术后放射外科治疗时的一个重要考虑因素是尽量减少手术至放射外科治疗的延迟。术前栓塞和更高的放射治疗剂量与改善的 LC 相关，值得进一步研究。
