Abugharib Ahmed, Zeng K Liang, Tseng Chia-Lin, Soliman Hany, Myrehaug Sten, Husain Zain, Maralani Pejman Jabehdar, Larouche Jeremie, Cheung Patrick, Emmenegger Urban, Atenafu Eshetu G, Sahgal Arjun, Detsky Jay S
Department of Clinical Oncology, Sohag University Hospital, Sohag University, Sohag, Egypt.
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Neurosurgery. 2022 Jun 1;90(6):743-749. doi: 10.1227/neu.0000000000001909. Epub 2022 Mar 30.
Stereotactic body radiotherapy (SBRT) is used to deliver ablative dose of radiation to spinal metastases.
To report the first dedicated series of spine SBRT specific to prostate cancer (PCa) metastases with outcomes reported according to hormone sensitivity status.
A prospective database was reviewed identifying patients with PCa treated with spine SBRT. This included those with hormone-sensitive PCa (HSPC) and castrate-resistant PCa (CRPC). The primary end point was MRI-based local control (LC).
A total of 183 spine segments in 93 patients were identified; 146 segments had no prior radiation and 37 had been previously radiated; 27 segments were postoperative. The median follow-up was 31 months. At the time of SBRT, 50 patients had HSPC and the remaining 43 had CRPC. The most common fractionation scheme was 24-28 Gy in 2 SBRT fractions (76%). LC rates at 1 and 2 years were 99% and 95% and 94% and 78% for the HSPC and CRPC cohorts, respectively. For patients treated with de novo SBRT, a higher risk of local failure was observed in patients with CRPC (P = .0425). The 1-year and 2-year overall survival rates were significantly longer at 98% and 95% in the HSPC cohort compared with 79% and 65% in the CRPC cohort (P = .0005). The cumulative risk of vertebral compression fracture at 2 years was 10%.
Favorable LC rates were observed after spine SBRT for PCa metastases; strategies to improve long-term LC in patients with CRPC require further investigation.
立体定向体部放射治疗（SBRT）用于向脊柱转移瘤给予消融剂量的辐射。
报告首个专门针对前列腺癌（PCa）转移瘤的脊柱SBRT系列研究，并根据激素敏感性状态报告结果。
回顾前瞻性数据库，确定接受脊柱SBRT治疗的PCa患者。这包括激素敏感性PCa（HSPC）和去势抵抗性PCa（CRPC）患者。主要终点是基于MRI的局部控制（LC）。
共确定93例患者的183个脊柱节段；146个节段既往未接受过放疗，37个节段既往接受过放疗；27个节段为术后。中位随访时间为31个月。在进行SBRT时，50例患者为HSPC，其余43例为CRPC。最常见的分割方案是2次SBRT分割，每次24 - 28 Gy（76%）。HSPC和CRPC队列1年和2年的LC率分别为99%和95%以及94%和78%。对于初治SBRT的患者，CRPC患者局部失败风险更高（P = 0.0425）。HSPC队列1年和2年总生存率显著更长，分别为98%和95%，而CRPC队列分别为79%和65%（P = 0.0005）。2年时椎体压缩骨折的累积风险为10%。
PCa转移瘤脊柱SBRT后观察到良好的LC率；改善CRPC患者长期LC的策略需要进一步研究。
