Lee Chia Ching, Tey Jeremy, Cheo Timothy, Lee Chau Hung, Wong Alvin, Kumar Naresh, Vellayappan Balamurugan
Department of Radiation Oncology, National University Cancer Institute, National University Hospital, National University Health System, National University of Singapore, Singapore, Singapore.
Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore.
Global Spine J. 2023 Mar;13(2):284-294. doi: 10.1177/2192568221994798. Epub 2021 Mar 2.
Retrospective cohort study.
To evaluate the outcomes of conventionally-fractionated external beam radiation therapy (cEBRT) in the treatment of prostate cancer spinal metastases (PCSM).
Patients who received palliative cEBRT for PCSM in our institution between 2008 and 2018 were included. Our outcomes were local progression-free survival (LPFS), overall survival (OS), pain response and toxicities graded using CTCAE version 4.03. Univariable and multivariable Cox proportional hazard regressions were performed to identify predictors for LPFS and OS.
A total of 100 patients with 132 sites of PCSM were identified, with a median follow-up of 54 months. Fourteen-percent of patients underwent surgical intervention before receiving cEBRT. Eighteen spinal segments (13.6%) had local progression, with a median time to local progression of 8 months. The median LPFS and OS were 7.8 and 9.0 months, respectively. The complete and partial pain response rates were 57% and 39% respectively. The incidence of grade ≥3 acute toxicities was 11%. Better ECOG performance status (0 to 1), castration-sensitive disease, spinal surgery and use of novel antiandrogen agent were identified as significant predictors for improved OS on multivariable analysis.
In our prostate cancer cohort, cEBRT is an effective treatment modality for local palliation of spinal metastases. More aggressive treatment approach should be considered for patients with excellent performance status and castration-sensitive disease in light of their expected longer survival. Further studies are warranted to identify the predictors for radiotherapy response in this population.
回顾性队列研究。
评估常规分割外照射放疗（cEBRT）治疗前列腺癌脊柱转移（PCSM）的疗效。
纳入2008年至2018年在本机构接受姑息性cEBRT治疗PCSM的患者。我们的观察指标为局部无进展生存期（LPFS）、总生存期（OS）、疼痛缓解情况以及使用CTCAE 4.03版分级的毒性反应。进行单变量和多变量Cox比例风险回归分析以确定LPFS和OS的预测因素。
共纳入100例患有132个PCSM病灶的患者，中位随访时间为54个月。14%的患者在接受cEBRT之前接受了手术干预。18个脊柱节段（13.6%）出现局部进展，局部进展的中位时间为8个月。LPFS和OS的中位时间分别为7.8个月和9.0个月。完全和部分疼痛缓解率分别为57%和39%。≥3级急性毒性反应的发生率为11%。多变量分析显示，较好的ECOG体能状态（0至1）、去势敏感型疾病、脊柱手术以及新型抗雄激素药物的使用是OS改善的显著预测因素。
在我们的前列腺癌队列中，cEBRT是局部缓解脊柱转移的有效治疗方式。鉴于预期生存期较长，对于体能状态良好和去势敏感型疾病的患者，应考虑更积极的治疗方法。有必要进一步开展研究以确定该人群放疗反应的预测因素。
