Ehret Felix, Mose Lucas, Kufeld Markus, Fürweger Christoph, Windisch Paul, Haidenberger Alfred, Schichor Christian, Tonn Jörg-Christian, Muacevic Alexander
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany.
European Cyberknife Center, Munich, Germany.
Front Oncol. 2021 May 28;11:642314. doi: 10.3389/fonc.2021.642314. eCollection 2021.
Due to recent medical advancements, patients suffering from metastatic spinal disease have a prolonged life expectancy than several decades ago, and some will eventually experience relapses. Data for the retreatment of spinal metastasis recurrences occurring at the very same macroscopic spot as the initially treated lesion are limited. Previous studies mainly included recurrences in the boundary areas as well as other macroscopic parts of the initially affected vertebrae. This study exclusively analyzes the efficacy and safety of spinal reirradiation for recurrences on the same site utilizing single-session robotic radiosurgery.
Patients between 2005 and 2020 who received radiotherapy for a spinal metastasis suffering from a local recurrence were eligible for analysis. Only patients undergoing a single-session reirradiation were included. All recurrences must have been occurred in the same location as the initial lesion. This was defined as a macroscopic recurrence on computed tomography occurring at the same site as the initial spinal metastasis. All other lesions, including those in the boundary areas or other parts of the initially affected vertebrae, were excluded.
Fifty-three patients with fifty-three lesions were retreated for spinal metastases. The median dose and number of fractions for the initial radiotherapy were 36 Gy and 15, respectively. Eleven patients were initially treated with stereotactic body radiotherapy. Retreatment was performed with a median dose of 18 Gy prescribed to a median isodose of 70%. The local control was 77% after a median follow-up of 22.2 months. Patients experiencing a second recurrence received a lower dose (p = 0.04), mostly below 18 Gy, and had a worse coverage (p = 0.01) than those showing local tumor control. 51% of patients experienced an improvement in pain control after treatment delivery. Besides, four vertebral compression fractures (7% of patients) but no other adverse events higher than grade 2 were observed.
Single-session robotic radiosurgery appears to be a safe, time-saving, and effective treatment modality for spinal metastasis recurrences occurring in the same initial location if a considerable dose and coverage can be applied. Treatment results are comparable to reirradiated metastases in the boundary areas.
由于近期医学的进步，与几十年前相比，患有转移性脊柱疾病的患者预期寿命延长，部分患者最终会复发。关于在与最初治疗病变相同的宏观部位发生的脊柱转移复发进行再治疗的数据有限。既往研究主要包括在边界区域以及最初受影响椎体的其他宏观部位的复发。本研究专门分析利用单次机器人立体定向放射外科对同一部位复发进行脊柱再照射的疗效和安全性。
2005年至2020年间因脊柱转移接受放疗后出现局部复发的患者符合分析条件。仅纳入接受单次再照射的患者。所有复发必须发生在与初始病变相同的位置。这被定义为计算机断层扫描上与初始脊柱转移相同部位的宏观复发。所有其他病变，包括边界区域或最初受影响椎体其他部位的病变，均被排除。
53例患者的53个病变接受了脊柱转移复发的再治疗。初始放疗的中位剂量和分次次数分别为36 Gy和15次。11例患者最初接受立体定向体部放疗。再治疗的中位剂量为18 Gy，处方中位等剂量线为70%。中位随访22.2个月后局部控制率为77%。与显示局部肿瘤控制的患者相比，经历第二次复发的患者接受的剂量更低（p = 0.04），大多低于18 Gy，且覆盖情况更差（p = 0.01）。51%的患者在治疗后疼痛控制得到改善。此外，观察到4例椎体压缩骨折（占患者的7%），但未观察到高于2级的其他不良事件。
如果能够给予相当的剂量和覆盖范围，单次机器人立体定向放射外科似乎是治疗在同一初始部位发生的脊柱转移复发的一种安全、省时且有效的治疗方式。治疗结果与边界区域再照射的转移瘤相当。
