From the Department of Radiation Oncology (S.G., S.B., K.K.), Department of Radiology (U.S., F.F.Y., A.A., B.R.S., K.M.R.), and Departments of Orthopaedic Surgery and Neurosurgery (S.V.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; and Rio Grande Urology, El Paso, Tex (J.T.M.).
Radiographics. 2021 Nov-Dec;41(7):2136-2156. doi: 10.1148/rg.2021210052. Epub 2021 Oct 8.
The fields of both radiology and radiation oncology have evolved considerably in the past few decades, resulting in an increased ability to delineate between tumor and normal tissue to precisely target and treat vertebral metastases with radiation therapy. These scientific advances have also led to improvements in assessing treatment response and diagnosing toxic effects related to radiation treatment. However, despite technological innovations yielding greatly improved rates of palliative relief and local control of osseous spinal metastases, radiation therapy can still lead to a number of acute and delayed posttreatment complications. Treatment-related adverse effects may include pain flare, esophageal toxic effects, dermatitis, vertebral compression fracture, radiation myelopathy, and myositis, among others. The authors provide an overview of the multidisciplinary approach to the treatment of spinal metastases, indications for surgical management versus radiation therapy, various radiation technologies and techniques (along with their applications for spinal metastases), and current principles of treatment planning for conventional and stereotactic radiation treatment. Different radiologic criteria for assessment of treatment response, recent advances in radiologic imaging, and both common and rare complications related to spinal irradiation are also discussed, along with the imaging characteristics of various adverse effects. Familiarity with these topics will not only assist the diagnostic radiologist in assessing treatment response and diagnosing treatment-related complications but will also allow more effective collaboration between diagnostic radiologists and radiation oncologists to guide management decisions and ensure high-quality patient care. RSNA, 2021.
在过去的几十年中，放射学和放射肿瘤学领域都有了相当大的发展，这使得我们能够更精确地区分肿瘤和正常组织，从而用放射疗法精确地靶向和治疗脊柱转移瘤。这些科学进步也导致了治疗反应评估和与放射治疗相关的毒性作用诊断方面的改进。然而，尽管技术创新大大提高了缓解疼痛和控制骨转移的局部控制率，但放射疗法仍可能导致许多急性和延迟性治疗后并发症。与治疗相关的不良反应可能包括疼痛加剧、食管毒性作用、皮炎、椎体压缩性骨折、放射性脊髓病和肌炎等。作者概述了治疗脊柱转移瘤的多学科方法、手术治疗与放射治疗的适应证、各种放射技术和技术（及其在脊柱转移瘤中的应用）以及常规和立体定向放射治疗的当前治疗计划原则。还讨论了不同的放射学评估治疗反应的标准、放射影像学的最新进展、与脊柱照射相关的常见和罕见并发症以及各种不良反应的影像学特征。熟悉这些主题不仅可以帮助诊断放射科医生评估治疗反应和诊断与治疗相关的并发症，还可以促进诊断放射科医生和放射肿瘤学家之间更有效的合作，以指导管理决策并确保高质量的患者护理。RSNA，2021。
