Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA.
Neurosurgery. 2022 Feb 1;90(2):199-206. doi: 10.1227/NEU.0000000000001780.
The management of spinal metastatic renal cell carcinoma (mRCC) is controversial regarding extent of resection and radiation dosing.
To determine outcomes in patients treated with hybrid therapy (separation surgery plus adjuvant stereotactic body radiation therapy [SBRT]) for mRCC.
A retrospective study of a prospectively collected cohort of patients undergoing hybrid therapy for mRCC between 2003 and 2017 was performed. SBRT was delivered as high-dose single-fraction, high-dose hypofractionated, or low-dose hypofractionated. Extent of disease, clinical and operative outcomes, and complications data were collected, and associations with overall survival (OS) and progression-free survival were determined.
Ninety patients with mRCC with high-grade epidural spinal cord compression (ESCC grades 2 and 3) were treated. Metastases were widespread, oligometastatic, and solitary in 56%, 33%, and 11% of patients, respectively. SBRT delivered was high-dose single-fraction, high-dose hypofractionated, and low-dose hypofractionated in 24%, 56%, and 20% of patients, respectively. The 1-yr cumulative incidence of major complications was 3.4% (95% confidence interval [CI]: 0.0%-7.2%). The median follow-up was 14.2 mo for the entire cohort and 38.3 mo for survivors. The 1-yr cumulative incidence of progression was 4.6% (95% CI: 0.2%-9.0%), which translates to a local control rate of 95.4% (95% CI: 91.0%-99.8%) 1 yr after surgery. The median OS for the cohort was 14.8 mo.
These data support the use of hybrid therapy as a safe and effective strategy for the treatment of renal cell spine metastases.
脊柱转移性肾细胞癌（mRCC）的治疗策略存在争议，包括手术切除范围和放疗剂量。
旨在确定接受混合治疗（分离手术加辅助立体定向体部放疗[SBRT]）的 mRCC 患者的治疗结果。
对 2003 年至 2017 年间接受 mRCC 混合治疗的前瞻性队列研究进行回顾性研究。SBRT 采用大剂量单次分割、大剂量亚分割和低剂量亚分割。收集疾病程度、临床和手术结果以及并发症数据，并确定与总生存（OS）和无进展生存的相关性。
90 例 mRCC 伴高级硬膜外脊髓压迫（ESCC 分级 2 和 3）患者接受治疗。转移灶在 56%、33%和 11%的患者中广泛存在、寡转移和单发。分别有 24%、56%和 20%的患者接受了大剂量单次分割、大剂量亚分割和低剂量亚分割 SBRT。主要并发症的 1 年累积发生率为 3.4%（95%置信区间[CI]：0.0%-7.2%）。全队列的中位随访时间为 14.2 个月，幸存者为 38.3 个月。1 年累积进展率为 4.6%（95%CI：0.2%-9.0%），术后 1 年局部控制率为 95.4%（95%CI：91.0%-99.8%）。该队列的中位 OS 为 14.8 个月。
这些数据支持将混合治疗作为治疗肾细胞脊柱转移的安全有效的策略。
