非脊柱骨转移瘤立体定向体部放疗后的骨密度与骨折风险
Bone density and fracture risk following SBRT for non-spine bone metastases.
作者信息
Cao Yilin, Stachelek Gregory C, Fu Wei, Song Daniel Y, Hales Russell K, Voong K Ranh, Meyer Jeffrey J, Quon Harry, Hu Chen, Redmond Kristin J
机构信息
Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD, USA.
Johns Hopkins University School of Medicine, Department of Statistics and Bioinformatics, Baltimore, MD, USA.
出版信息
J Radiosurg SBRT. 2021;7(3):199-206.
PURPOSE/METHODS: This retrospective study evaluated local recurrence (LR) and fracture risk in non-spine bone metastases treated with SBRT.
RESULTS
181 lesions in 116 patients are reported. The median dose was 27 Gy (range 15-40) in 3 fractions (range 1-6). The cumulative incidence of LR was 2.8%, 7.2% and 12.5% at 6 mo, 1 yr and 2 yrs. Fractures occurred in 11 lesions (6%). Radioresistant histology and increasing PTV predicted for LR on univariate analysis, while rib location was associated with control. Increasing PTV remained a significant predictor for LR on multivariate analysis. Univariate predictors of fracture risk included female gender, lytic lesions and poorer KPS. Average CT-approximated L1 trabecular attenuation in patients with fracture was significantly lower than in patients without fracture (112.2 vs. 142.6 Hounsfield units).
CONCLUSION
In the largest series to date, we report excellent local control for SBRT to non-spine bone metastases and a novel relationship between CT-based bone quality assessment and fracture risk.
目的/方法：本回顾性研究评估了接受立体定向体部放疗（SBRT）治疗的非脊柱骨转移瘤的局部复发（LR）和骨折风险。
结果
报告了116例患者的181个病灶。中位剂量为27 Gy（范围15 - 40），分3次照射（范围1 - 6次）。6个月、1年和2年时LR的累积发生率分别为2.8%、7.2%和12.5%。11个病灶（6%）发生了骨折。在单因素分析中，放射抵抗性组织学和计划靶体积（PTV）增大预示着LR，而肋骨部位与局部控制相关。在多因素分析中，PTV增大仍然是LR的显著预测因素。骨折风险的单因素预测因素包括女性、溶骨性病灶和较差的体力状况评分（KPS）。骨折患者的平均CT近似L1小梁衰减显著低于无骨折患者（112.2对142.6亨氏单位）。
结论
在迄今为止最大的系列研究中，我们报告了SBRT治疗非脊柱骨转移瘤具有出色的局部控制效果，以及基于CT的骨质量评估与骨折风险之间的新关系。
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