Ito Kei, Sugita Shurei, Nakajima Yujiro, Hozumi Takahiro, Yamakawa Kiyofumi, Fujiwara Masanori, Karasawa Katsuyuki
Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, 113-8677, Tokyo, Japan.
Department of Orthopedic surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, 113-8677, Tokyo, Japan.
Clin Exp Metastasis. 2021 Apr;38(2):219-225. doi: 10.1007/s10585-021-10078-y. Epub 2021 Feb 24.
To assess the additional effects of intraoperative radiotherapy (IORT) with decompression surgery and adjuvant external beam radiotherapy (EBRT) for metastatic epidural spinal cord compression (MESCC). This single-arm institutional prospective observational study recruited patients between June 2017 and March 2020 and included those with symptoms of spinal cord compression owing to metastases, who were diagnosed using MRI. Patients with radiation-sensitive primary tumors and those who could not tolerate surgery were excluded. The treatment protocol comprised decompression surgery and electron beam IORT of 20 Gy in a single fraction followed by EBRT of 30 Gy in 10 fractions. The primary endpoints included the 1-year local failure rate and ambulatory functions. The study was closed in May 2019 owing to changes in treatment policies at our institution. Twenty patients were registered between June 2017 and May 2019. Although all patients completed surgery and IORT, 2 did not receive postoperative EBRT. Patients most commonly had colorectal cancer (4 patients), followed by thyroid cancer, renal cell carcinoma, lung cancer, breast cancer, sarcomas, and other cancers (3, 3, 2, 2, 2, and 4 patients, respectively). The median follow-up duration was 16 months (range 2-30 months); the 1-year local failure rate was 16%. On comparing ambulatory functions pre-treatment and at 1 year after treatment, improvement, no change, and worsening were observed in 3, 9, and 0 patients, respectively. This study's findings suggest that decompression surgery and IORT followed by EBRT are effective in achieving local control and maintaining ambulation in patients with MESCC.
评估术中放疗（IORT）联合减压手术及辅助外照射放疗（EBRT）对转移性硬膜外脊髓压迫（MESCC）的附加效果。这项单臂机构前瞻性观察性研究于2017年6月至2020年3月招募患者，纳入因转移导致脊髓压迫症状且经MRI诊断的患者。排除对放疗敏感的原发性肿瘤患者及无法耐受手术的患者。治疗方案包括减压手术及单次分割20 Gy的电子束IORT，随后进行10次分割共30 Gy的EBRT。主要终点包括1年局部失败率及行走功能。由于本机构治疗政策的变化，该研究于2019年5月结束。2017年6月至2019年5月期间登记了20例患者。尽管所有患者均完成了手术及IORT，但2例未接受术后EBRT。患者最常见的原发癌为结直肠癌（4例），其次为甲状腺癌、肾细胞癌、肺癌、乳腺癌、肉瘤及其他癌症（分别为3例、3例、2例、2例、2例及4例）。中位随访时间为16个月（范围2 - 30个月）；1年局部失败率为16%。比较治疗前及治疗后1年的行走功能，分别有3例、9例及0例患者出现改善、无变化及恶化。本研究结果表明，减压手术及IORT后行EBRT对MESCC患者实现局部控制及维持行走能力有效。
